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不同迷走神经切断术和幽门成形术后液体的胃排空情况。

Gastric emptying of liquids after different vagotomies and pyloroplasty.

作者信息

Gleysteen J J, Burdeshaw J A, Hallenbeck G A

出版信息

Surg Gynecol Obstet. 1976 Jan;142(1):41-8.

PMID:800
Abstract

Gastric emptying of five liquid meals which differ in their physicochemical properties have been measured in control dogs and dogs that have received a Heinecke-Mikulicz pyloroplasty alone, proximal gastric vagotomy without drainage, selective gastric vagotomy and pyloroplasty and truncal vagotomy and pyloroplasty. The first two phases of emptying have been computed by the method of least squares to obtain a logarithmic-linear pattern and are expressed as relative rates: The initial post-ingestion process is characterized by beta or the average relative rate of emptying in the first ten minutes, the basic or exponential rate as beta and the change in rate from the initial to basic pattern as deltabeta. Each measure of gastric emptying was statistically analyzed to determine specific differences in rates between the operations studied. We confirmed the earlier claims that pyloroplasty alone does not change the emptying rate of liquid meals. Each measure or phase of emptying varies consistently across the operations from meal to meal tested. Initial emptying after all three vagotomies is significantly faster than control with progressive rate increases as proximal gastric vagotomy is compared with selective gastric vagotomy with pyloroplasty and with truncal vagotomy with pyloroplasty, probably indicative of gastric fundal loss of accommodation to volume distention after denervation. The basic exponential pattern of emptying is not lost after any of the operations studied. The basic rate after proximal gastric vagotomy and selective gastric vagotomy with pyloroplasty is nearly identical, slightly delayed from the control rate and significantly slower than the more rapid rate after truncal vagotomy with pyloroplasty. Possible explanations for these are discussed and imply a particular importance of the hepatic and celiac vagal fibers, sectioned only with truncal vagotomy, in the regulation of gastric emptying of liquids.

摘要

已对五只对照犬以及分别接受了单纯海涅克-米库利奇幽门成形术、近端胃迷走神经切断术(无引流)、选择性胃迷走神经切断术加幽门成形术以及迷走神经干切断术加幽门成形术的犬,测量了五种理化性质不同的流食的胃排空情况。采用最小二乘法计算排空的前两个阶段,以获得对数线性模式,并表示为相对速率:摄入后的初始过程以β表示,即前十分钟的平均排空相对速率,基本或指数速率为β,从初始模式到基本模式的速率变化为δβ。对每种胃排空测量值进行统计分析,以确定所研究手术之间速率的具体差异。我们证实了早期的说法,即单纯幽门成形术不会改变流食的排空速率。所测试的每餐在不同手术中的每种排空测量值或阶段均一致变化。所有三种迷走神经切断术后的初始排空均明显快于对照,随着近端胃迷走神经切断术与选择性胃迷走神经切断术加幽门成形术以及迷走神经干切断术加幽门成形术相比较,速率逐渐增加,这可能表明去神经后胃底对容量扩张的适应性丧失。在所研究的任何手术之后,排空的基本指数模式均未丧失。近端胃迷走神经切断术和选择性胃迷走神经切断术加幽门成形术后的基本速率几乎相同,略迟于对照速率,且明显慢于迷走神经干切断术加幽门成形术后更快的速率。对这些情况的可能解释进行了讨论,这意味着仅在迷走神经干切断术中切断的肝迷走神经纤维和腹腔迷走神经纤维在液体胃排空调节中具有特殊重要性。

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