功能性消化不良患者胃窦幽门十二指肠运动功能的研究

Antropyloroduodenal dyscoordination in functional dyspepsia studied by color Doppler flow imaging

目的探讨胃窦幽门十二指肠运动功能在功能性消化不良（ＦＤ）发病中的作用。方法采用彩色多普勒超声技术对胃的蠕动周期、排空周期、胃窦幽门十二指肠协调收缩及幽门功能进行了研究。结果１４名正常人餐后胃收缩频率平均为３．１５±０．０２次／分，２１例ＦＤ病人为３．１８±０．０２次／分（Ｐ值＞０．０５）。正常人及ＦＤ病人餐后各时间段平均胃排空时间无明显差异。正常组＞１０秒的胃排空周期百分率为５３．３％，ＦＤ组为３２．４％（Ｐ值＜０．０１）。餐后胃窦幽门十二指肠协调收缩百分率为７１．０％，ＦＤ组为５８．３％（Ｐ值＜０．００１）。２１例病人中有５例表现有幽门关闭不全，占２３．８％。１４例正常人中无一例出现幽门关闭不全。

Objective The aim of the study was to investigate the physiology and pathophysiology of gastric liquid emptying in healthy subject (HS) and in patients with functional dyspepsia (FD).Methods Fourteen HS and 21 FD were studied by color Doppler flow imaging (HP 8500 GP). After an overnight fast, all HS and patients were placed in a sitting position. Totally 300 ml liquid meal (P:C:F=1:1:7, 1.26×10 3 kJ) was consumed. The ultrasonographic probe was positioned at transpyloric plane to visualize the movement of gastric wall, the opening and closure of pylorus and transpyloric movement of intragastric contents for 120 minutes postprandially except for a short break at 70～90 minutes. Results (1) No significant difference was observed between the contractile frequency in HS (3.15±0.02 cpm) and in FD (3.18±0.02 cpm). The cycle lengths of gastric contraction were 19.20±0.37, 19.03±0.29 and 18.98±0.64 sec. in HS and 18.97±0.30, 18.68±0.26 and 18 88±0.58 sec. in FD during the first, second, and forth half hour. A vary stable pattern was observed in both normal and dyspeptic group ( P >0.05). (2) The average emptying time during the first, second and forth half hour were 8.63±1.72, 9.68±4.16 and 8.48±1.85 sec. in HS and 7.88±1.17, 8.12±2.22 and 7.70±1 64 sec. in FD respectively. No significant difference was found between these two groups ( P >0.05). The percentage of emptying time >10 sec. decreased significantly in FD (32.4%) compared with HS (53.3%, P <0 01). (3) The percentage of antropyloroduodenal contraction decreased significantly in FD (58.3%) compared with HS (71.0%, P <0.001). (4)Pyloric incompetence was found in 5 out of 21 patients (23.8%), but not in any healthy subject. A continuous interchange of anterograde and retrograde transpyloric flows could be observed in all these 5 patients by both color and Doppler sonography. Conclusion (1) Gastric contractile frequency during postprandial stage keeps a very stable pattern in either HS and FD group. (2)The coordination of antropyloroduodenum may play a key role in gastric emptying of liquids. (3) Pyloric incompetence impairs the coordination of antropyloroduodenal motility and the shivering capacity of pylorus. The dysfunction of pylorus and dyscoordination of antropyloroduodenal motility may be important factors for delayed gastric emptying and pathogenesis of functional dyspepsia.