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[胃切除术对胆囊运动的影响:一项实验研究]

[Effect of gastrectomy on gallbladder motility: an experimental study].

作者信息

Nakada K

机构信息

Department of Surgery II, Jikei University School of Medicine, Tokyo.

出版信息

J Smooth Muscle Res. 1995 Feb;31(1):23-32. doi: 10.1540/jsmr.31.23.

Abstract

Gallstone formation is frequently seen following gastric surgery. Since dysmotility and bile stasis of the gallbladder is considered as an important factor in the pathogenesis of gallstone formation, altered gallbladder motility due to gastric surgery may have a role in the development of post-gastrectomy gallstone formation. To test this hypothesis, the effect of distal partial gastrectomy on gallbladder motility were studied. Gastroduodenal and gallbladder contractions were recorded by chronically implanted strain gauge transducers under conscious state. Gallbladder volume changes were monitored using chronically indwelling gallbladder catheter. Fasted and fed motility were studied in control (n = 5) and gastrectomized (n = 3) dogs. Plasma concentration of putative hormone CCK was measured. Effect of CCK-OP and motilin on gallbladder emptying were also studied. In fasted state, gallbladder volume was periodically decreased synchronous with phase 3 of interdigestive migrating contractions (IMC) in the gastroduodenum in both group of dogs. The correlation between gastric and gallbladder contractions was preserved even following distal partial gastrectomy, though the frequency of phasic contractions during phase 3 of IMC was decreased in the gastrectomized dogs. Postprandial gallbladder emptying tend to decreased in the gastrectomized dogs, while there were no difference in the postprandial plasma CCK concentrations and CCK-OP induced gallbladder emptying between groups. Digestive period was shortened in the gastrectomized dogs, which resulted in early gallbladder refilling and prolonged interdigestive period. Decreased frequency of gallbladder phasic contractions during IMC and prolonged interdigestive period could cause bile stasis in the gallbladder, which may, in part, explain post-gastrectomy gallbladder formation.

摘要

胆结石形成常见于胃部手术后。由于胆囊运动障碍和胆汁淤积被认为是胆结石形成发病机制中的重要因素,胃部手术导致的胆囊运动改变可能在胃切除术后胆结石形成过程中起作用。为验证这一假设,研究了远端部分胃切除术对胆囊运动的影响。在清醒状态下,通过长期植入的应变片传感器记录胃十二指肠和胆囊的收缩情况。使用长期留置的胆囊导管监测胆囊体积变化。对对照组(n = 5)和胃切除组(n = 3)的犬进行禁食和进食状态下的运动研究。测量血浆中假定激素胆囊收缩素(CCK)的浓度。还研究了CCK-OP和胃动素对胆囊排空的影响。在禁食状态下,两组犬的胆囊体积均与胃十二指肠消化间期移行性复合运动(IMC)的第3相同步周期性减小。即使在远端部分胃切除术后,胃和胆囊收缩之间的相关性仍然存在,尽管胃切除组犬在IMC第3相期间的阶段性收缩频率降低。胃切除组犬餐后胆囊排空倾向于减少,而两组间餐后血浆CCK浓度以及CCK-OP诱导的胆囊排空无差异。胃切除组犬的消化期缩短,导致胆囊早期再充盈和消化间期延长。IMC期间胆囊阶段性收缩频率降低和消化间期延长可导致胆囊胆汁淤积,这可能部分解释了胃切除术后胆囊结石的形成。

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