贲门周围血管离断术后胃动力障碍的病因分析与预防措施

Stomach adynamia after pericardial devascularization

目的探讨贲门周围血管离断术 (PD)后胃动力障碍的原因与预防。方法将杂种狗2 4只平均分为对照组、保留迷走神经主干的贲门周围血管离断术 (VTPPD)组和PD组。分别测定其幽门括约肌动作电位和胃腔内压力 ,将VTPPD应用于临床 ,观察其效果。结果VTPPD组的胃平滑肌动作电位与对照组相似 ,比PD组高 12～ 2 5倍 ,1个动作电位末立即出现 1次收缩波 ,很有节律 ,而PD组则相反。采用VTPPD治疗门静脉高压症患者 4 2例 ,并与同期施行的PD 32例 ,PD加幽门成型术 (PP) 16例进行比较。术后胃肠功能平均恢复时间VTPPD组为 3 2d ,PD组为 5 7d ,PD加PP组为 4 2d ,3组之间差异有显著意义 (P <0 0 5 )。胃液滞留、恶心、呕吐、突发性腹泻和肠胃返流发生率均明显低于PD组和PD加PP组。 3组之间的再出血率和死亡率差异无显著意义 (P >0 0 5 )。结论PD术后胃动力障碍的主要原因是切断了支配幽门胃窦区的迷走神经 ,VTPPD能有效地预防这一并发症。

ObjectiveTo study the causes and prevention of stomach adynamia after pericardial devascularization(PD). MethodsTwenty-four mongrel dogs were equally divided into three groups. Group A served as control, group B received vagus trunk preserving pericardial devascularization(VTPPD), and group C only pericardial devascularization(PD). The action current of pyloric muscle and the pyloric pressure were measured on all dogs. Clinically, 42 patients received VTPPD, results were compared with that of 32 portal hepertensive cases undergoing PD. Results The action current of the sphincter muscle in VTPPD dogs, similar to that of group A, was 12 to 25 times as high as that in the PD group ( P <0.01). At the end of an action current a contraction wave came rhythmically, which was in sharp contrast to that in PD group. Clinically, the recovery time for the gastroenteric function, averaged 3.5 days in 42 VTPPD cases shorter than that in 32 PD cases and 16 PD+PP (pyloroplasty) cases averaging at 5.7 and 4.2 days respectively ( P <0.05). Incidence of gastric retention, diarrhea and enterogastric reflux was significantly lower than that in the other two groups. There were no differences on follow-up mortality and rebleeding rates between the three groups ( P >0.05). Conclusions Stomach adynamia after PD procedure is mainly caused by interruption of vagus branches to pylorus and gastric antrum. The VTPPD procedure can effectively prevent this complication.