Hould F S, Cullen J J, Kelly K A
Department of Surgery, Mayo Clinic, Rochester, Minn.
Surgery. 1994 Jul;116(1):83-9.
The aim was to determine the effect of proximal gastric vagotomy on proximal gastric tone, distal gastric motility, and gastric emptying in seven conscious dogs.
Before vagotomy, insulin (1 unit/kg intravenously) caused a prompt decrease in proximal gastric tone measured with a barostat and a marked increase in distal gastric motility measured with a perfused, pressure-sensitive catheter, both of which were maximal at 30 minutes. Proximal gastric tone then returned to the control level during the ensuing 30 minutes, whereas the increase in distal gastric motility continued. Gastric emptying of an inert marker, polyethylene glycol, was unchanged by insulin. After vagotomy, insulin again caused a prompt decrease in proximal gastric tone, an increase in distal gastric motility, and no change in gastric emptying of marker, but the decrease in proximal gastric tone now persisted for the entire hour after administration of insulin.
Relaxation of the proximal stomach is mediated by pathways not solely dependent on the proximal gastric vagal nerves, but the ability to regain proximal gastric tone is impaired by proximal vagotomy. In contrast, vagal drive to distal gastric motility and gastric antral emptying are preserved after proximal gastric vagotomy.
目的是确定近端胃迷走神经切断术对7只清醒犬近端胃张力、远端胃动力和胃排空的影响。
在迷走神经切断术前,静脉注射胰岛素(1单位/千克)可使通过恒压器测量的近端胃张力迅速降低,以及使通过灌注的压力敏感导管测量的远端胃动力显著增加,两者在30分钟时达到最大值。随后的30分钟内近端胃张力恢复到对照水平,而远端胃动力的增加持续存在。胰岛素对惰性标记物聚乙二醇的胃排空无影响。迷走神经切断术后,胰岛素再次使近端胃张力迅速降低,远端胃动力增加,标记物的胃排空无变化,但胰岛素给药后近端胃张力的降低现在持续了整整一小时。
近端胃的松弛由并非仅依赖于近端胃迷走神经的途径介导,但近端胃迷走神经切断术损害了恢复近端胃张力的能力。相比之下,近端胃迷走神经切断术后,迷走神经对远端胃动力和胃窦排空的驱动得以保留。