Pechlivanides G, Xynos E, Chrysos E, Tzovaras G, Fountos A, Vassilakis J S
2nd Surgical Department, Athens Naval and Veterans Hospital, Greece.
Am J Surg. 1994 Oct;168(4):335-9. doi: 10.1016/s0002-9610(05)80160-6.
It has been shown that truncal vagotomy with pyloroplasty (TVP), but not highly selective vagotomy (HSV), delays the onset, decreases the extent, and changes the pattern of gallbladder emptying. The aim of the present study was to investigate any alterations in gallbladder emptying after a variety of antiulcer gastric surgery, by milk-technetium 99m (99mTc)-dimethyl iminodiacetic acid (HIDA) scintigraphy. After excluding the cases with spontaneous gallbladder evacuation before milk ingestion, there were 26 controls, 41 duodenal ulcer (DU) patients, 22 after HSV (15 prospective cases), 50 after TVP (23 prospective cases), 8 after TV with gastrojejunostomy (TV-GJ), 10 after Billroth I gastrectomy, and 29 after Billroth II gastrectomy. None of the patients with gastrectomy had additional vagotomy. TVP significantly delayed the onset and decreased the rate of gallbladder emptying as compared with the control, DU, HSV, and Billroth I groups. TVP also changed the pattern of emptying in 20% of the cases (sequential emptying and refilling events). Antiulcer operations excluding the duodenum (TV-GJ and Billroth II) further reduced the rate of gallbladder emptying as compared with (1) control, DU, HSV, and Billroth I groups (P < 0.0001) and (2) TVP (P < 0.001). Onset of gallbladder emptying was not affected by Billroth II gastrectomy, but was significantly delayed by TV-GJ (P < 0.001). The latter two operations also significantly changed the pattern of gallbladder emptying, exhibiting sequential emptying and refilling events, in most cases (P < 0.01 versus TVP). In conclusion, all antiulcer procedures, except HSV, greatly disturb the pattern, the onset, and the rate of gallbladder emptying. Truncal vagotomy seems to disrupt vagally mediated preduodenal mechanism, resulting in delayed onset and reduced rate, whereas duodenal exclusion by gastrojejunostomy results in severely decreased rate of gallbladder emptying.
研究表明，胃大部切除加幽门成形术（TVP）而非高选择性迷走神经切断术（HSV）会延迟胆囊排空的起始时间、减少排空程度并改变排空模式。本研究旨在通过牛奶 - 锝99m（99mTc） - 二甲基亚氨基二乙酸（HIDA）闪烁扫描术，调查各种抗溃疡胃部手术后胆囊排空的任何变化。在排除摄入牛奶前胆囊自发排空的病例后，有26名对照组、41名十二指肠溃疡（DU）患者、22名接受高选择性迷走神经切断术（HSV）后的患者（15例前瞻性病例）、50名接受胃大部切除加幽门成形术（TVP）后的患者（23例前瞻性病例）、8名接受胃空肠吻合术的迷走神经切断术（TV - GJ）后的患者、10名毕罗一世胃切除术后的患者以及29名毕罗二世胃切除术后的患者。胃切除患者均未进行额外的迷走神经切断术。与对照组、十二指肠溃疡组、高选择性迷走神经切断术组和毕罗一世胃切除组相比，胃大部切除加幽门成形术（TVP）显著延迟了胆囊排空的起始时间并降低了排空率。胃大部切除加幽门成形术（TVP）还在20%的病例中改变了排空模式（出现顺序排空和再充盈事件）。与（1）对照组、十二指肠溃疡组、高选择性迷走神经切断术组和毕罗一世胃切除组（P < 0.0001）以及（2）胃大部切除加幽门成形术（TVP）组（P < 0.001）相比，不涉及十二指肠的抗溃疡手术（TV - GJ和毕罗二世胃切除术）进一步降低了胆囊排空率。毕罗二世胃切除术未影响胆囊排空的起始时间，但胃空肠吻合术的迷走神经切断术（TV - GJ）显著延迟了起始时间（P < 0.001）。后两种手术也显著改变了胆囊排空模式，在大多数情况下出现顺序排空和再充盈事件（与胃大部切除加幽门成形术（TVP）相比，P < 0.01）。总之，除高选择性迷走神经切断术（HSV）外，所有抗溃疡手术均极大地扰乱了胆囊排空的模式、起始时间和速率。胃大部切除加迷走神经切断术似乎破坏了迷走神经介导的十二指肠前机制，导致起始时间延迟和速率降低，而胃空肠吻合术导致的十二指肠排除则导致胆囊排空率严重降低。
