胃手术后的胆汁反流与残胃粘膜病变的研究  

A study of the bile reflux and histologic changes in gastric remnant mucosa following gastric surgery

作　　者：张超[1] 黄文[1] 

机构地区：[1]第三军医大学西南医院普外科

出　　处：《中华普通外科杂志》1997年第4期250-252,共3页Chinese Journal of General Surgery

摘　　要：为了解胃手术方式对胆汁反流及残胃粘膜的影响，作者观察了６５例残胃患者［毕氏１式１７例，毕氏Ⅱ式２０例，选择性迷走神经切断加胃窦部切除１６例，高选择性迷走神经切断（ＨＳＶ）１２例］及１５例溃疡病患者胃液胆酸浓度、ｐＨ及胃内细菌变化，并对残胃粘膜进行组织学检查。发现各种胃手术组胃液胆酸浓度均高于溃疡病组（对照组），其中Ｂ－Ⅱ组胃液胆酸浓度、ｐＨ及菌量升高最明显，而ＨＳＶ组则显著低于其他各手术组（Ｐ＜０．０１），残胃粘膜组织学异常改变的程度亦显著低于其他手术组（Ｐ＜０．０５，Ｐ＜０．０１）。结果表明：胃手术方式对胆汁反流可产生重要影响，残胃粘膜组织学异常改变与胃液胆酸浓度、ｐＨ的升高以及胃内菌量的增多有关。作者认为，选用保留幽门及生理功能的术式，能减少肠胃反流的发生，对预防残胃粘膜出现癌前病变及癌变有重要意义。The bile acid, PH and total bacterial counts (TBC)of gastric aspirates were assessed in 65 patients after gastric surgery (Billroth Ⅰin 17 cases, BillrothⅡin 20 cases,SV+A in 16 cases,and HSV in 12 cases)and 15 patients with peptric ulcer(control group).Endoscopy and biopsy of gastric mucosa were performed.Significantly elevated intragstric concentratios of bile acid were found in all the 4 operative groups.The intragastric bile acid concetrations, PH and TBC in B-Ⅱgroup were the highest,whereas they were the lowest in HSV group (P<0.05-0.01 ).A significant positive correlation was shown not only between PH and TBC (r=0.78,P<0.01),but also between intragastric PH and bile acid concentrations(r=0.45,P<0.05).The abnormal histologic alterations in gastric remnant mucosa were more common in B-Ⅰ,B-Ⅱ and SV+A groups than in HSV group(P<0.05,P<0.01).It was shown that the methods of gastric surgery play an important role affecting the bile reflux,and the abnormal histology of gastric mucosa was closely related to the bile acid concentrations,PH and TBC in the gastric juice.It was suggested that preserving pylorus and it's physiologic function reduces the bile reflux.

关 键 词：胃切除 胃粘膜 胃溃疡 胆汁迫流 手术后并发症 

分 类 号：R656.610.6[医药卫生—外科学]