Hotokezaka M, Combs M J, Mentis E P, Schirmer B D
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
Ann Surg. 1996 Apr;223(4):413-9. doi: 10.1097/00000658-199604000-00010.
The authors investigate the recovery of gastrointestinal motility in the fed and fasted state after laparoscopic and open cholecystectomy.
Clinical recovery after laparoscopic cholecystectomy is known to be more rapid than after conventional open cholecystectomy. However, the actual effect of a laparoscopic approach on gastrointestinal motility, particularly fed-state motility, is not well investigated.
Laparoscopic (LAP, n=6) or open (OPEN, n=6) cholecystectomy was performed in 12 dogs. Bipolar recording electrodes were placed on the antrum, small intestine, and the transverse and descending colon, and fasting myoelectric data were recorded after operation. Solid meal gastric emptying studies were performed before surgery and on postoperative days 1 and 2. Transit time studies were performed using 10 radiopaque markers.
Gastric emptying was significantly delayed in the OPEN group at 120 minutes on postoperative day 1 compared with pre-operative emptying (p<0.05), but was not delayed on postoperative day 2. Gastric emptying was not delayed in the LAP group after operation. Transit time was the same between groups. Gastric dysrhythmias were more frequent on postoperative day 3 (p<0.05) in the OPEN group. There were no significant differences in the presence, cycle length, or propagation velocity of the migrating motor complex on any postoperative day. Discrete or continuous electrical response activity in the colon was observed by postoperative day 1 in both groups.
Fed-state motility is the only parameter for which laparoscopic cholecystectomy showed an improvement in postoperative recovery. Recovery of fasted gastrointestinal motility in dogs is equally rapid after either operation.
作者研究腹腔镜胆囊切除术和开腹胆囊切除术后进食和禁食状态下胃肠动力的恢复情况。
已知腹腔镜胆囊切除术后的临床恢复比传统开腹胆囊切除术后更快。然而，腹腔镜手术对胃肠动力，特别是进食状态下动力的实际影响尚未得到充分研究。
对12只犬进行腹腔镜（LAP，n = 6）或开腹（OPEN，n = 6）胆囊切除术。将双极记录电极置于胃窦、小肠、横结肠和降结肠上，术后记录禁食时的肌电数据。术前及术后第1天和第2天进行固体餐胃排空研究。使用10个不透X线的标志物进行转运时间研究。
与术前排空相比，OPEN组术后第1天120分钟时胃排空明显延迟（p<0.05），但术后第2天未延迟。LAP组术后胃排空未延迟。两组间转运时间相同。OPEN组术后第3天胃节律失常更频繁（p<0.05）。术后任何一天，移行运动复合波的存在、周期长度或传播速度均无显著差异。两组术后第1天均观察到结肠离散或连续的电反应活动。
进食状态下的动力是腹腔镜胆囊切除术在术后恢复方面表现出改善的唯一参数。两种手术术后犬禁食胃肠动力的恢复同样迅速。
