胆囊切除后十二指肠胃反流的临床研究

Clinical study of duodenogastric reflux after cholecystectomy

本研究通过检测１４例胆囊结石病人胆囊切除术前后胃内胆酸含量，发现其十二指肠胃反流（ＤＧＲ）发生率分别为８５７１％和１００％，正常对照组为２１４３％，差异显著（Ｐ＜０．０１）；同时检测手术前后血清胃泌素分别为１６２９５±５６２８ｐｇ／ｍｌ、１４７．８７±３７．６１ｐｇ／ｍｌ，均显著高于对照组１０５０５±２６．８５ｐｇ／ｍｌ，而基础胃酸排量、最高胃酸排量与对照组比较无明显差异。作者分析，此种病人胃肠道激素改变是影响Ｏｄｄｉ括约肌运动状态和胃－幽门－十二指肠协调运动的主要因素，亦即是引起ＤＧＲ的基本原因，也是胆囊切除术后综合征的原因之一，其治疗可选用促胃肠动力药物。

The content of bile acid in gastric juice was determined to justify duodenogastric reflux (DGR) in 14 cases of Cholecystolithiasis before and after Cholecystectomy. The incidence of DGR before and after Cholecystectomy were 85.71% and 100% respectively which were significantly different from that in the control group which was 21.43% ( P<0.01 ). The contents of seral gastressin before and after Cholecystectomy were 162.75±56.28pg/ml and 147.87±37.61pg/ml which were significantly higher than that in the control group which was 105.05±26.85pg/ml. The basal acid output and maximal acid output were not significantly different between the gallstone and control group. The authors consider that the change of gastrointestinal hormone is the primary factor affecting the movement of Oddis sphincter and the gastropyloroduodenal harmonious movement that is the basic cause of DGR and is one of the reasons of postcholecystectomy symptoms. The symptoms caused by DGR can be treated by gastrointestinal dynamic drugs.