门奇静脉断流术对胆囊运动功能的影响  

Effect of portal azygous disconnection on gallbladder motor function

作　　者：金红旭[1] 吴硕东[2] 张雪峰[1] 陈宪英[3] 张国旭[3] 

机构地区：[1]中国人民解放军沈阳军区总医院普通外科,辽宁省沈阳市110016 [2]中国医科大学附属二院普外二科,辽宁省沈阳市110003 [3]中国人民解放军沈阳军区总医院核医学科,辽宁省沈阳市110016

出　　处：《世界华人消化杂志》2004年第11期2655-2659,共5页World Chinese Journal of Digestology

摘　　要：目的:利用脾切除、贲门周围血管离断术,即Hassab手术时切断迷走神经,脾切除、胃冠状静脉栓塞术时保留迷走神经这一特点,应用放射性核素动态显像的方法,对比研究两种术式术前术后胆囊运动功能,为进一步阐明人迷走神经在胆囊运动中的作用提供有力依据. 方法:明确诊断肝硬化门静脉高压症患者23例,其中Hassab手术组18例,术中切断迷走神经前后干;栓塞术组5例,行脾切除后结扎胃冠状静脉并穿刺注射TH胶.全组患者均在术前及术后第10 d空腹静脉注射99mTc-EHIDA(二乙基乙酰替苯胺亚氨二醋酸)动态显像,0.25分/帧.连续30 min后食标准脂餐,再连续动态显像60 min.画出胆囊感兴趣区(ROI),建立时间放射性曲线,分析注射99mTc- EHIDA 30 min后胆囊的放射性计数(GBRC30 min)、排胆分数(GBEF)、排胆期(GBEP)、排胆率(GBER)、潜伏期(GBLP)、潜伏期放射性计数的增量(GBLI)、潜伏期放射性计数的增加率(GBLR)等指标. 结果:Hassab手术组术后GBRC30 min较术前明显减少(74.8±66.9 vs 155.7±72.9,P<0.05);术前的GBLP很短,术后的GBLP却明显延长(13.36±5.92 vs2.24±1.48, P<0.01).在GBLP内胆囊的放射性计数逐渐增加,但术前的GBLI及GBLR很小,而术后的GBLI及GBLR明显增加(79.5±56.3 vs 9.2±11.7.113.4±49.5 vs 7.6±10.8. P<0.01);术后GBEP明显缩短(18.5±6.3 vs 24.1 ±6.4, P<0.05),GBEF和GBER明显降低(13.1±5.4 vs 32.3±16.3,0.7±0.3 vs 1.4±0.8,P<0.01).栓塞术组各指标术前术后均无显著差异. 结论:切断迷走神经后消化问期胆囊的张力明显减低,餐后的胆囊收缩延迟、运动功能明显减弱.AIM: To investigate and clarify the effect of vagus on gallbladder motility through a comparative study. METHODS: Twenty-three hepatocirrhosis patients with portal hypertension were included in this study. In Hassab operation group, the anterior and posterior trunk of vagus were surgically excised (H, n = 18); In vena coronaria ventriculi embolization group, the vena coronaria ventri culi bole was ligated and injected TH adhesive (8 mL) after splenectomy (VCE, n = 5). Before operation and 10 d after operation, 99mTc-labeled diethyl acetyl acid anilide iminodiacetic acid (99mTc-EHIDA, 185 MBq) was administered intravenously to the patients, and then scintigraphic method was used to assess the motor function of gallbladder. The index including radiocounting 30 min after injected 99mTc-EHIDA (GBRC 30min), emptying fraction (GBEF), emptying period (GBEP), emptying rate (GBER), latent period (GBLP), latent period radiocounting increment (GBLI) and latent period radiocounting increment rate (GBLR) were analyzed. RESULTS: GBRC 30 min in H group was significantly lower after operation than that before operation (74.8±66.9 vs 155.7±72.9, P <0.05); GBLP was very short in pre operation, and GBLP prolonged significantly after operation (13.36±5.92 vs 2.24±1.48, P<0.01); the gallbladder radiocounting increased gradually during GBLP; the GBLI and GBLP level were very low before operation, but the GBLI and GBLP increased significantly after operation (79.5±56.3 vs 9.2±11.7, 113.4±49.5 vs 7.6±10.8, P<0.01); GBEP shortened significantly after operation (18.5±6.3 vs 24.1±6.4, P<0.05); GBEF and GBER decreased obviously after operation (13.1±5.4 vs 32.3± 16.3, 0.7±0.3 vs 1.4±0.8, P <0.01). The preceding parameters in VCE group had no significant difference before and after operation (P >0.05). CONCLUSION: The gallbladder tension weakens obviously in interdigestive phase after the vagus is excised; the gallbladder contraction delays, and the motor function weakens obviously after meals.

关 键 词：门奇静脉断流术 胆囊运动功能 脾切除 贲门周围血管离断术 

分 类 号：R657.3[医药卫生—外科学]