经腹吻合器门奇断流术对肝硬化门静脉高压症犬胃动力学的影响

Influence of portal-azygos devascularization via abdomen with stapler on gastric motility in portal hypertension canines with liver cirrhosis

目的:探讨经腹吻合器门奇断流术对胃动力学的影响及术中行幽门成形术的意义.方法:将肝硬化门静脉高压症模型犬18只,随机分为3组:A组:经腹吻合器门奇断流术;B组:经腹吻合器门奇断流术加幽门成形术;C组:对照组即假手术组.分别于术前3d、术后7、14及21d采用单切面实时超声显像法行流体餐胃动力学多项指标检测.结果:A组术后7d与术前相比,胃半排空时间、胃全排空时间明显延长,胃窦收缩频率、胃窦收缩幅度、胃窦运动指数明显下降(101.8±16.89minvs63.22±12.67min,215.0±31.26minvs153.7±22.45min,0.96±0.21vs2.11±0.55,0.12±0.03vs0.20±0.04,0.17±0.05vs0.47±0.13,均P<0.05),术后14d除胃窦收缩频率外,其他各项胃动力学指标已恢复至术前水平.术后21d时胃窦收缩频率与术前相比,差异无显著性.B组术后7d与术前相比,胃半排空时间、胃全排空时间差异无显著性,胃窦收缩频率明显下降(0.91±0.38vs2.04±0.49,P<0.05),但与A组差异无显著性.术后21d胃窦收缩频率与术前相比,差异无显著性.C组术后7d各项胃动力学指标已恢复至术前水平.结论:门静脉高压症犬行经腹吻合器门奇断流术中附加幽门成形术仅在术后1wk内改善胃排空状况,经腹吻合器门奇断流术可不必常规行幽门成形术.

AIM： To investigate influence of portal-azygos devascularization via abdomen with stapler on gastric motility in portal hypertension canines with liver cirrhosis and the significance of pyloroplasty. METHODS： Eighteen portal hypertension canines with liver cirrhosis were randomly divided into three groups. Portal-azygos devascularization via abdomen with stapler was performed in group A, while portal-azygos devascularization via abdomen with stapler and pyloroplasty were performed in group B. Sham operation was performed in group C, the control group. The changes of gastric motility in all canines were studied using real-time ultrasonography. RESULTS： In group A, gastric emptying halftime and emptying time were delayed, gastric peristalsis frequency, amplitude and motility indices were reduced at day 7 post-operation compared with pre-operation （101.8 ± 16.89 min vs 63.22 ± 12.67 min, 215.0 ±31.26 min vs 153.7 ±22.45 min, 0.96± 0.21 vs 2.11 ± 0.55, 0.12±0.03 vs 0.20 ± 0.04, 0.17 ± 0.05 vs 0.47 ± 0.13, all P 〈 0.05）. Fourteen days after operation, all other indices except for gastric peristalsis frequency returned to the pre-operation levels （P 〉 0.05）. At day 21 post-operation, there was no significant difference in gastric peristalsis frequency compared with pre-operation （P 〉 0.05）. In group B, gastric emptying half-time and emptying time at day 7 post-operation returned to the pre-operation levels （P 〉 0.05）, but gastric peristalsis frequency was reduced （0.91 ± 0.38 vs 2.04 ± 0.49, P 〈 0.05）. At day 21 post-operation, there was no significant difference in gastric peristalsis frequency compared with pre-operation. All indices returned to the pre-operation levels in group C at day 7 post-operation. CONCLUSION： Pyloroplasty improves gastric emptying only in 7 days after portal-azygos devascularization via abdomen with stapler. It is unnecessary to add pyloroplasty regularly in portal-azygos devascularization via abdomen with stapler.