Thomas H, Heimbucher J, Fuchs K H, Freys S M, DeMeester T R, Peters J H, Bremner C G, Thiede A
Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Arch Surg. 1996 Jan;131(1):63-6. doi: 10.1001/archsurg.1996.01430130065011.
To compare motility of a Roux-en-Y esophagojejunostomy after total gastrectomy with normal jejunal motility and to determine the effect on motility of the incorporation of a pouch in the reconstruction.
Jejunal motility in normal subjects was compared with jejunal motility in the Roux-en-Y reconstruction with and without a Hunt-Lawrence pouch.
The case were collected during a 4-year period at a university hospital. The mean time from resection to study was 14 months (range, 4 to 49 months).
Seven control patients were compared with 10 patients with a Roux-en-Y reconstruction and 17 with a Roux-en-Y and Hunt-Lawrence pouch.
The fasting-state motility of the jejunum used for reconstruction was measured by a water-perfused manometric system for 2 to 4 hours with the subject in the supine position.
Compared with normal subjects, patients with a Roux-en-Y esophagojejunostomy without a pouch had an increased number of phases of the interdigestive motor complex per hour (P < .05). The phases were of shorter duration with a random sequence and increased total time spent in the quiescent phase 1 (P < .05). In patients with a pouch, no differences were detected between the motility in the pouch and the efferent limb. Compared with those without a pouch, there were significantly fewer orthograde interdigestive motor complex phase 3 fronts and more total time spent in phase 1 (P < .05).
Construction of a gastric substitute from jejunum leads to substantial motility changes. The addition of a pouch decreases the overall activity, which may contribute to the storage function of the pouch.
比较全胃切除术后Roux-en-Y食管空肠吻合术的蠕动与正常空肠蠕动，并确定重建术中加用贮袋对蠕动的影响。
将正常受试者的空肠蠕动与有或无Hunt-Lawrence贮袋的Roux-en-Y重建术中的空肠蠕动进行比较。
病例收集于一所大学医院4年期间。从切除到研究的平均时间为14个月（范围4至49个月）。
7名对照患者与10名接受Roux-en-Y重建术的患者以及17名接受Roux-en-Y和Hunt-Lawrence贮袋手术的患者进行比较。
使用水灌注测压系统，在受试者仰卧位时，测量用于重建的空肠在禁食状态下2至4小时的蠕动情况。
与正常受试者相比，未使用贮袋的Roux-en-Y食管空肠吻合术患者每小时消化间期移行性复合运动的相数增加（P < .05）。这些相的持续时间较短，顺序随机，且静息期1所花费的总时间增加（P < .05）。在使用贮袋的患者中，贮袋和输出袢的蠕动未检测到差异。与未使用贮袋的患者相比，顺行性消化间期移行性复合运动3期波峰明显减少，且在1期所花费的总时间更多（P < .05）。
用空肠构建胃替代物会导致显著的蠕动变化。加用贮袋可降低整体活动度，这可能有助于贮袋的储存功能。
