高选迷切加胃窦粘膜切除术及单纯高选迷切对胃运动功能的影响  

The Effect of Highly Selective Vagotomy Plus Mucosal Antrectomy and Highly Selective Vagotomy Alone on Motor Function of Gastric Antrum

作　　者：文亚渊[1] 王代科[1] 刘宝华[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所普通外科,重庆400042

出　　处：《中国普外基础与临床杂志》2002年第2期105-107,共3页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的　了解高选迷走神经切断术加胃窦粘膜切除术 (HSV MA)和单纯高选迷走神经切断术 (HSV)对胃窦运动功能的影响。方法　将 18只犬随机均分成 3组 (对照组、HSV组、HSV MA组 ) ,术后 4～ 6个月测胃排空时间、胃窦肌电活动及胃窦压。 48例十二指肠溃疡患者随机分成HSV MA组 (2 8例 )和HSV组 (2 0例 ) ,术后 4～ 6个月行胃排空、胃电图 (EGG)频率及振幅和胃酸检查 ,并与术前水平作比较。结果　X线钡餐检查发现术后两组患者及犬的胃和十二指肠形态正常 ,胃蠕动波清晰可见。在犬HSV MA组 ,胃的初排及排空时间分别为 (5 .0± 0 .0 6)min及 (4 .0± 0 .4)h ,和对照组及HSV组相近 (P >0 .0 5 )。犬HSV MA组胃窦肌电动作电位频率是 (3 .11± 0 .65 )次 /分 ,患者HSV MA组胃电图频率为 (3 .2 5± 0 .75 )次 /分 ,均明显低于相应对照组及HSV组 (P<0 .0 5 )。肌注 5 肽胃泌素或进餐能明显增加胃窦压及胃电图振幅。胃酸分泌HSV MA组及HSV组相似 ,但均明显低于对照组。结论　尽管胃肌电频率稍低 ,但HSV MA后胃窦运动功能接近正常。因此 ,HSVObjective To investigate the effects of highly selective vagotomy plus mucosal antrectomy (HSV MA) and highly selective vagotomy (HSV) alone on the functions of the gastric antrum. Methods Eighteen dogs and 48 patients with chronic duodenal ulcer were tested. The time of gastric emptying, antral myoelectric activity, antral pressure were measured 4-6 months after operation in 18 dogs which were randomized into the control, HSV and HSV MA groups. The gastric evacuation, frequency and amplitude of electrogastrography (EGG) were observed 4-6 months after operation in 48 patients who were randomly divided into HSV (20 patients) and HSV MA (28 patients) group, their preoperative values were considered as control group. Results It was found by barium meal examinations that the shape of the stomach and duodenum was normal and gastric peristalsis was clearly visible in all the animals and patients of two postoperative groups. The beginning and ending time of gastric emptying were (5.0±0.06) min and (4.0±0.4) h respectively in the dogs of HSV MA group, which were similar to those of the dogs of control and HSV group ( P >0.05). The frequency of the antral myoelectric action potential was (3.11±0.65 ) cycles/min in the dogs of HSV MA group, the frequency of EGG was (3.25±0.75) cycles/min in the patients of HSV MA group, which were significantly lower than that of the dogs or patients of control and HSV group ( P <0.05). Injection of pentagastrin in dogs or taking meal in patients significantly increased the antral pressure or amplitude of EGG. Conclusion The motor function of the reconstructed antrum in the HSV MA group approaches the normal level despite a lower antral myoelectric frequency. It is believed that HSV MA will be a choice for the treatment of duodenal ulcer.

关 键 词：高选迷走神经切断术 胃窦粘膜切除术 胃运动功能 胃电图 

分 类 号：R656.6[医药卫生—外科学]