胃大部切除术不同重建方式对胃液胆酸浓度和胃内菌丛的影响  

RELATIONSHIP BETWEEN BILE ACID CONCENTRATION AND MICROFLORA IN FASTING GASTRIC JUICE FOLLOWING DIFFERENT POST GASTRECTOMIC RECONSTRUCTION

作　　者：张超[1,2] 梅霞[1,2] 吴国庆[1,2] 蔡志民 黄文[1,2] 

机构地区：[1]第三军医大学西南医院普外科 [2]重庆市外科医院

出　　处：《中华消化内镜杂志》1998年第6期345-348,共4页Chinese Journal of Digestive Endoscopy

摘　　要：为了解胃大部切除术不同重建方式对胃液胆酸浓度和胃内菌丛的影响，观察了４４例溃疡病患者胃大部切除术不同重建方式前后空腹胃液胆酸浓度及胃内菌量变化，并对术后１年的３２例进行胃粘膜组织学检查。发现Ｂｉｌｒｏｔｈ－Ⅱ组和Ｂｉｌｒｏｔｈ－Ⅰ组术后胃液胆酸浓度及菌量均显著高于保留幽门、胃窦浆肌瓣式（ＰＡＦＰＧ）组（Ｐ＜０．０５，Ｐ＜０．０１），前两组胃粘膜组织学异常改变的程度也较ＰＡＦＰＧ组严重（Ｐ＜０．０５）。结果表明：胃大部切除术由于重建方式的不同对术后的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升高和胃内细菌增多有关；ＰＡＦＰＧ能较有效地减少肠胃反流，使胃内环境保持相对稳定。Bile acids and total bacterial counts (TBC) in gastric juice were measured in 44 patients with peptic ulcer before and after subtotal gastrectomy to investigate the influence of different reconstruction after gastrectomy on bile acid concentration and microflora in fasting gastric juice. Gastric mucosal biopsies obtained from 32 patients were studied one year postoperatively. Results showed that gastric bile acid concentration in both B Ⅱ and B Ⅰ group were singnificantly higher than that in pylorus antroseromuscular flap preserving gastrectomy (PAFPG) group following operation (P<0 05～0.01).TBC in B Ⅱ or B Ⅰ group were much more increased than that in PAFPG (P<0 05～0.01).The abnomal histologic changes in gastric remnant mucosa were more commonly seen after B Ⅱ or B Ⅰ reconstruction, compared with PAFPG (P<0 05).These findings suggest that the type of reconstruction after subtotal gastrectomy would affect bile reflux, abnomal histologic changes in gastric remnant mucosa be closely related with elevation of bile acid concentraion and increase of TBC in gastric juice. PAFPG could prevent bile reflux effectively

关 键 词：胃大部切除术 胃手术 胆汁反流 胃内细菌 

分 类 号：R656.61[医药卫生—外科学]