远端胃大部分切除后Roux-en-Y消化道重建术对小肠排空影响的实验研究

An experimental study of the Roux-en-Y reconstruction on intestinal evacuation in rats undergoing subtotal gastrectomy

目的 探讨胃大部切除Roux en Y胃空肠吻合术后小肠的排空功能。方法 本实验应用放射性核素锝标记试餐的方法 ,研究SD鼠胃部分切除Billroth I,Roux en Y及Roux en Y式吻合附加迷走神经干切断 3种胃肠道重建术式的胃肠排空状态。结果 各组胃肠放射活性分布显示 :假手术 ,Billroth I及Roux en Y吻合术式的胃肠道放射活性呈双峰分布 ,其中第二放射峰 ,假手术位于中段小肠 ,Billroth I趋向中远段小肠 ,Roux en Y靠近近中段小肠 ;Roux en Y附加迷走神经切断组呈单峰 ,分布于残胃和近段小肠 ;与Billroth I组近胃十二指肠吻合第一段小肠放射活性相比 ,Roux肠绊组近胃空肠吻合第一段小肠滞留明显 (Roux en Y组 ,P <0 0 5 ,Roux en Y附加迷走神经切断组 ,P <0 0 1) ,表明Roux en Y重建组有近段小肠试餐淤积问题 ,以迷走神经切断更明显。结论 研究结果提示胃部分切除Roux en

Objective To investigate the effect of Roux en Y gastrointestinal reconstruction on the function of small bowel evacuation in rats undergoing subtotal gastrectomy. [WT5”HZ]Methods[WT5”BZ] Using radiolabeled test meal we studied the postoperative gastrointestinal evacuation in rats receiving GI reconstructions of Billroth Ⅰ,Roux en Y and Roux en Y plus truncal vagotomy(TV) respectively after subtotal gastrectomy.[WT5”HZ]Results[WT5”BZ] The bimodal distributions of radioactivity in GI tract were found in the sham,Billroth I, and Roux en Y group. The second radioactive peak was in the middle portion of the intestine in sham group,in the middle and distal portion in Billroth I group and in the proximal and middle portion in Roux en Y group. The unimodal radioactive peak was shown in the gastric remanant and the proximal small bowel in Roux en Y plus TV group. Compared with Billroth Ⅰ group the stasis of radioactive test meal in the first intestinal segment in groups with Roux en Y reconstruction was more obvious(Billroth I vs Roux en Y P <0 05, Billroth I vs Roux en Y plus TV P <0 01). [WT5”HZ]Conclusion[WT5”BZ] The findings strongly suggested that vagotomy was not responsible for the stasis problem in proximal small intestine often seen clinically in Roux en Y GI reconstruction.