Aiko S, Ando N, Shinozawa Y, Ozawa S, Kitajima M, Kurose I, Tsuchiya M
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Clin Gastroenterol. 1993;17 Suppl 1:S161-6. doi: 10.1097/00004836-199312001-00028.
Peptic ulcers in the gastric tube for esophageal replacement develop in spite of reduction of acid secretion after truncal vagotomy and often result in serious conditions such as bleeding and perforation. Thirteen cases of gastric tube ulcers were detected endoscopically from 1985 to 1990 in our hospital. Most of these ulcers developed within 20 cm of the anastomosis (esophagogastrostomy), which was an especially hypoxic and ischemic area. Ischemic change due to decreased blood supply is suggested as a causative factor in ulcer development. Recent studies indicate that chemiluminescence (ChL) activity may increase even in the low-flow hypoxic condition. Therefore, we investigated the ChL of regional blood in the hypoxic gastric tube in dogs. The ChL activity of the blood sample collected from the ischemic region in the gastric tube significantly increased after construction of the gastric tube, compared with systemic blood from the femoral vein, and the number of leukocytes decreased in the ischemic region. We believe that oxygen radicals derived from neutrophils adhering to the vascular endothelium may play an important role in the damage to endothelial cells of the gastric tube and suggest the possibility of their causative effects in the process of ulcer formations.
尽管行迷走神经干切断术后胃酸分泌减少，但用于食管替代的胃管仍会发生消化性溃疡，且常导致出血和穿孔等严重情况。1985年至1990年期间，我院经内镜检查发现13例胃管溃疡。这些溃疡大多发生在吻合口（食管胃吻合术）20厘米范围内，该区域尤其缺氧和缺血。血液供应减少导致的缺血改变被认为是溃疡形成的一个致病因素。最近的研究表明，即使在低流量缺氧状态下，化学发光（ChL）活性也可能增加。因此，我们研究了犬缺氧胃管局部血液的ChL。与股静脉采集的全身血液相比，胃管缺血区域采集的血样ChL活性在胃管构建后显著增加，且缺血区域白细胞数量减少。我们认为，黏附于血管内皮的中性粒细胞产生的氧自由基可能在胃管内皮细胞损伤中起重要作用，并提示它们在溃疡形成过程中具有致病作用的可能性。
