Shinchi H, Takao S, Fukura K, Aikou T
First Department of Surgery, Kagoshima University School of Medicine, Japan.
J Surg Res. 1996 Feb 15;61(1):152-8. doi: 10.1006/jsre.1996.0097.
Pancreaticogastrostomy has been reintroduced as a useful alternative procedure to pancreaticojejunostomy after Whipple resection or pylorus-preserving pancreaticoduodenectomy because of the very low incidence of leakage and disruption. In this study, gastric acid secretion, serum gastrin level, and 24-hr dual gastroduodenal pH after pancreaticogastrostomy were examined on the assumption that a canine model was a pylorus-preserving pancreaticoduodenectomy. Basal acid output (BAO), maximal acid output (MAO), and dual gastroduodenal pH were measured in eight dogs with gastric fistula. After pancreaticogastrostomy, BAO levels showed a slight increase significantly, but MAO levels showed no change. Serum gastrin levels in the fasting and postprandial states showed the similar patterns between before and after surgery. In the 24-hr dual gastroduodenal pH monitoring, gastric pH and duodenal pH also did not change in the fasting and postprandial states. These results suggested that the maintenance of the normal gastric pH after pancreaticogastrostomy was caused by a little increase of BAO, and the neurohumoral relationship between the stomach, duodenum, and pancreas was preserved even after pancreaticogastrostomy. Therefore, the pancreaticogastrostomy is a recommendable reconstructive procedure physiologically after pylorus-preserving pancreaticoduodenectomy.
由于胰胃吻合术的渗漏和破裂发生率极低，它已被重新引入，作为胰十二指肠切除术或保留幽门的胰十二指肠切除术后胰肠吻合术的一种有用替代手术。在本研究中，假设犬模型为保留幽门的胰十二指肠切除术，对胰胃吻合术后的胃酸分泌、血清胃泌素水平和24小时胃十二指肠双pH值进行了检测。对8只患有胃瘘的犬测量了基础胃酸分泌量（BAO）、最大胃酸分泌量（MAO）和胃十二指肠双pH值。胰胃吻合术后，BAO水平显著略有升高，但MAO水平无变化。空腹和餐后状态下的血清胃泌素水平在手术前后呈现相似模式。在24小时胃十二指肠双pH值监测中，空腹和餐后状态下的胃pH值和十二指肠pH值也没有变化。这些结果表明，胰胃吻合术后正常胃pH值的维持是由BAO略有增加引起的，即使在胰胃吻合术后，胃、十二指肠和胰腺之间的神经体液关系也得以保留。因此，胰胃吻合术是保留幽门的胰十二指肠切除术后一种生理上值得推荐的重建手术。
