胆囊切除术后胃电图及胃肠道压力变化

The changes of electrogastrogram and gastrointestinal pressure following cholecystectomy

目的探讨腹部手术后胃肠运动功能障碍的机理。方法对２２例胆囊切除患者行手术前后胃电图描记，并对其中１７例行术后胃窦、十二指肠和空肠测压。结果术后当天胃电正常波所占百分比、术后胃电幅度均较术前有显著意义的降低（Ｐ＜００１）；术后胃窦部移行性运动复合波（ＭＭＣ）Ⅲ期最早出现于十二指肠，胃窦出现最晚，次数最少；术后胃窦ＭＭＣⅢ期平均压力和收缩曲线面积明显小于十二指肠和空肠，差异有显著意义（Ｐ＜００５）。结论腹部手术后胃肠运动功能障碍与胃电幅度降低密切相关；术后胃窦部ＭＭＣⅢ期恢复明显落后于十二指肠和空肠，这是胃排空障碍的重要原因。

Objective To investigate the mechanism and pathophysioloical changes after abdominal surgery. Method Twenty two patients after cholecystectomy were selected to perform cutaneous electrogastrography(EGG) at least one hour before operation,and the first,the second and the third day after operation respectively.On the operative and postoperative days,gastroduodenojejunal manometry was performed in 17 of the 2 palients. Result The percentage of EGG normal frequency on the operative day was obviously lower than that on the preoperative day( P <0 001),and the percentage of bradygastria on the operative day was obviously higher than that on the preoperative day ( P <0 01). The postoperative EGG amplitude was obviously lower than the preoperative one ( P <0 001),and did not recover after three days. The phase Ⅲ of the migrating motor complex (MMC) appeared within 24 hours after operation,and first appeared at the duodenum. MMCⅢ was most vogorous at the duodenum in recording period,and was less at the antrum. The contractile power and the area of MMCⅢ at antrum after toperation were obviously lower than at duodenum and upper jejunum( P <0 01). On the third day after operation,the contractile power was lower than normal( P <0 01). Conclusion Gastrointestinal motility dysfunction after cholecystectomy is related to EGG amplitude,and not to EGG frequency. The recovery of antrum MMCⅢ is later than that of small bowl,resulting in delayed gastric emptying. The MMCⅢ of small bowl resums in early period after abdominal surgery. Postoperative ileum is due the decrease of MMCⅢ contractile power and the area after abdominal syrgery,which represent the ability of gastrointestinal contraction.