Gastrointestinal hormones appear to be important modulators of bile flow and composition. Insulin and glucagon induce choleresis at physiologic levels and may alter lipid output and concentration as well. The effects of many hormones such as insulin, glucagon, secretin, and pancreatic polypeptide are at least partially independent of their effects on neurovascular factors. Furthermore, recently studied hormones such as somatostatin, vasoactive intestinal polypeptide, and pancreatic polypeptide have also been shown not only to alter bile flow but to affect bile composition. Understanding the role of gastrointestinal hormones in hepatic physiology may elucidate the causes of gallstone formation, disorders of biliary excretion, and hypercholesteremic states.
{"title":"Hormonal contributions to biliary secretion.","authors":"P Calhoun, J B Hanks","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Gastrointestinal hormones appear to be important modulators of bile flow and composition. Insulin and glucagon induce choleresis at physiologic levels and may alter lipid output and concentration as well. The effects of many hormones such as insulin, glucagon, secretin, and pancreatic polypeptide are at least partially independent of their effects on neurovascular factors. Furthermore, recently studied hormones such as somatostatin, vasoactive intestinal polypeptide, and pancreatic polypeptide have also been shown not only to alter bile flow but to affect bile composition. Understanding the role of gastrointestinal hormones in hepatic physiology may elucidate the causes of gallstone formation, disorders of biliary excretion, and hypercholesteremic states.</p>","PeriodicalId":79268,"journal":{"name":"Surgical gastroenterology","volume":"3 2","pages":"8-16"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"17153267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thirty patients with cysts of the cephalic portion of the pancreas treated by operation between 1966 and 1980 were reviewed to determine whether any variation existed from the usual treatment of cysts of the body and tail of the gland. Sixteen patients had chronic pancreatitis, six had acute pancreatitis, four had cysts of indeterminate causes, three had adenocarcinoma of the pancreas, and in one patient a cyst developed after external trauma. External drainage was used in 14 patients, internal drainage in ten patients, and combinations of cyst drainage and anastomosis of Wirsung's duct or resection were performed in six patients. No operative deaths occurred, and the rate of cyst recurrence was minimal. Diabetes mellitus developed in 40% of patients with chronic pancreatitis despite conservative management. Recurrent pain in 13 patients and the discovery of associated carcinoma in one patient at initial treatment and later in two others cast doubt on the usefulness of simple internal or external drainage of cysts for pain except in a setting of acute pancreatitis. Resection of the pancreatic head or drainage of dilated pancreatic ducts should more often be carried out in the primary treatment of cephalic cysts with pain due to chronic pancreatitis.
{"title":"Surgical management of cysts of the head of the pancreas.","authors":"J W Braasch, J M Gubern, R L Rossi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Thirty patients with cysts of the cephalic portion of the pancreas treated by operation between 1966 and 1980 were reviewed to determine whether any variation existed from the usual treatment of cysts of the body and tail of the gland. Sixteen patients had chronic pancreatitis, six had acute pancreatitis, four had cysts of indeterminate causes, three had adenocarcinoma of the pancreas, and in one patient a cyst developed after external trauma. External drainage was used in 14 patients, internal drainage in ten patients, and combinations of cyst drainage and anastomosis of Wirsung's duct or resection were performed in six patients. No operative deaths occurred, and the rate of cyst recurrence was minimal. Diabetes mellitus developed in 40% of patients with chronic pancreatitis despite conservative management. Recurrent pain in 13 patients and the discovery of associated carcinoma in one patient at initial treatment and later in two others cast doubt on the usefulness of simple internal or external drainage of cysts for pain except in a setting of acute pancreatitis. Resection of the pancreatic head or drainage of dilated pancreatic ducts should more often be carried out in the primary treatment of cephalic cysts with pain due to chronic pancreatitis.</p>","PeriodicalId":79268,"journal":{"name":"Surgical gastroenterology","volume":"3 2","pages":"17-22"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"17602020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Over a period of 22 years (1958-1980), 52 children with cholelithiasis were treated in the Hunan Medical College Hospital in Ghangsha, China. Enteric helminthiasis is a common endemic disease in China and the countries of the Far East. Common in this region also is biliary ascariasis, which can precipitate an abdominal emergency in children. Both these conditions make differentiation of primary acute cholecystitis from the acute cholecystitis that is a complication of biliary ascariasis difficult in children. But, whatever the etiology of the disease, cholelithiasis was confirmed in all 52 children, an incidence of 1:62.4 the frequency of this disease in adults, or eight times higher than that which occurs in Western countries. Table 1 shows the distribution according to sex and age in our patients.
{"title":"Cholelithiasis in children in a Chinese hospital: report of 52 cases.","authors":"C S Chu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Over a period of 22 years (1958-1980), 52 children with cholelithiasis were treated in the Hunan Medical College Hospital in Ghangsha, China. Enteric helminthiasis is a common endemic disease in China and the countries of the Far East. Common in this region also is biliary ascariasis, which can precipitate an abdominal emergency in children. Both these conditions make differentiation of primary acute cholecystitis from the acute cholecystitis that is a complication of biliary ascariasis difficult in children. But, whatever the etiology of the disease, cholelithiasis was confirmed in all 52 children, an incidence of 1:62.4 the frequency of this disease in adults, or eight times higher than that which occurs in Western countries. Table 1 shows the distribution according to sex and age in our patients.</p>","PeriodicalId":79268,"journal":{"name":"Surgical gastroenterology","volume":"3 2","pages":"27-8"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"17602021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hydrostatic balloon dilatation has been used successfully to treat several patients with stomal stenosis occurring as a late complication of gastroplasty. The technique of hydrostatic balloon dilatation practiced in this institution is reviewed in detail. This technique appears to offer several advantages over previous techniques: 1) the procedure can be accomplished with intravenous sedation eliminating the need for general anesthesia; 2) trauma to the gastric channel is minimized because no attempt is made to manipulate the endoscope through the stoma into the distal stomach; 3) radiopaque markers on the polyethylene balloon catheter permit easy and accurate positioning of the balloon within the gastric channel; 4) the low compliance characteristics of the polyethylene balloon used permit inflation to a predetermined outer diameter with minimum risk of balloon deformity or overdistention and rupture; and 5) the procedure is easily standardized and can therefore be expected to yield reproducible results. Late stomal stenosis after gastric partitioning may respond to conservative therapy including nutritional support and dietary counselling. Hydrostatic balloon dilatation should be considered as the preferred method of stomal dilatation in patients refractory to alternative forms of management.
{"title":"Hydrostatic balloon dilatation for stomal stenosis after gastric partitioning.","authors":"F E Eckhauser, J A Knol, W E Strodel, K Cho","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Hydrostatic balloon dilatation has been used successfully to treat several patients with stomal stenosis occurring as a late complication of gastroplasty. The technique of hydrostatic balloon dilatation practiced in this institution is reviewed in detail. This technique appears to offer several advantages over previous techniques: 1) the procedure can be accomplished with intravenous sedation eliminating the need for general anesthesia; 2) trauma to the gastric channel is minimized because no attempt is made to manipulate the endoscope through the stoma into the distal stomach; 3) radiopaque markers on the polyethylene balloon catheter permit easy and accurate positioning of the balloon within the gastric channel; 4) the low compliance characteristics of the polyethylene balloon used permit inflation to a predetermined outer diameter with minimum risk of balloon deformity or overdistention and rupture; and 5) the procedure is easily standardized and can therefore be expected to yield reproducible results. Late stomal stenosis after gastric partitioning may respond to conservative therapy including nutritional support and dietary counselling. Hydrostatic balloon dilatation should be considered as the preferred method of stomal dilatation in patients refractory to alternative forms of management.</p>","PeriodicalId":79268,"journal":{"name":"Surgical gastroenterology","volume":"3 1","pages":"43-50"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"17579268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In vivo myoelectrical activity and pressure of the SO have been studied in intact, vagotomized and splanchnicectomized rabbits. Preganglionic nerve sections made no significant differences compared to the control group. Acetylcholine (3-11 mu g/kg) and adrenaline (1-50 micrograms/kg) increased and decreased respectively the myoelectrical activity. Hyoscine (0.5 mg/kg) and verapamil (35 micrograms/kg/min.) but not pentolinium (2 mg/kg) inhibited the excitatory activity of ACh; phentolamine (3 mg/kg) but not propranolol (3 mg/kg) antagonized the inhibitory activity of adrenaline. It can be concluded that the neurotransmission in the rabbit SO has both pathways: excitatory transmission mediated by cholinergic muscarinic receptors which are calcium dependent, and relaxation mediated by inhibitory alpha-adrenoceptors.
{"title":"Role of the autonomic nervous system in the rabbit sphincter of Oddi.","authors":"J C Sarles, R Awad","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In vivo myoelectrical activity and pressure of the SO have been studied in intact, vagotomized and splanchnicectomized rabbits. Preganglionic nerve sections made no significant differences compared to the control group. Acetylcholine (3-11 mu g/kg) and adrenaline (1-50 micrograms/kg) increased and decreased respectively the myoelectrical activity. Hyoscine (0.5 mg/kg) and verapamil (35 micrograms/kg/min.) but not pentolinium (2 mg/kg) inhibited the excitatory activity of ACh; phentolamine (3 mg/kg) but not propranolol (3 mg/kg) antagonized the inhibitory activity of adrenaline. It can be concluded that the neurotransmission in the rabbit SO has both pathways: excitatory transmission mediated by cholinergic muscarinic receptors which are calcium dependent, and relaxation mediated by inhibitory alpha-adrenoceptors.</p>","PeriodicalId":79268,"journal":{"name":"Surgical gastroenterology","volume":"3 2","pages":"41-6"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"17167968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Squamous papilloma of the esophagus is a rare benign tumor. A 51-year-old patient had chronic symptoms of esophagitis, and squamous papilloma was found in the mid-esophagus. The endoscopic appearance and histology are described, after endoscopic polypectomy.
{"title":"Endoscopic removal of squamous cell papilloma of esophagus: a case report and review of literature.","authors":"A N Shah","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Squamous papilloma of the esophagus is a rare benign tumor. A 51-year-old patient had chronic symptoms of esophagitis, and squamous papilloma was found in the mid-esophagus. The endoscopic appearance and histology are described, after endoscopic polypectomy.</p>","PeriodicalId":79268,"journal":{"name":"Surgical gastroenterology","volume":"3 2","pages":"23-6"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"17460722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Between November 1980 and October 1982, 11 patients underwent modified Sugiura procedures (esophageal transection, gastric devascularization, and splenectomy) for bleeding esophageal varices, with an operative mortality of 36%. One patient rebled at 2 months and was successfully managed by sclerotherapy. Intraoperative portal pressure fell approximately 25% after splenectomy. We contend that esophageal transection and gastric devascularization provide good short-term control of bleeding varices, and that the decrease in portal pressure provided by splenectomy allows scars to form during a period of reduced portal pressure, providing long-term arrest of variceal hemorrhage.
{"title":"Control of bleeding esophageal varices by transabdominal esophageal transection, gastric devascularization, and splenectomy.","authors":"J L Weese, J R Starling, C E Yale","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Between November 1980 and October 1982, 11 patients underwent modified Sugiura procedures (esophageal transection, gastric devascularization, and splenectomy) for bleeding esophageal varices, with an operative mortality of 36%. One patient rebled at 2 months and was successfully managed by sclerotherapy. Intraoperative portal pressure fell approximately 25% after splenectomy. We contend that esophageal transection and gastric devascularization provide good short-term control of bleeding varices, and that the decrease in portal pressure provided by splenectomy allows scars to form during a period of reduced portal pressure, providing long-term arrest of variceal hemorrhage.</p>","PeriodicalId":79268,"journal":{"name":"Surgical gastroenterology","volume":"3 1","pages":"31-6"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"17396763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N Komi, T Tamura, Y Miyoshi, K Kunitomo, H Udaka, H Takehara
A nationwide survey of cases of choledochal cyst was conducted to obtain the data on cases of choledochal cyst in Japan between 1972 and 1982. A total of 645 cases in 73 institutions, including 52 cases from this hospital, were surveyed. Choledochal cyst was associated with an anomalous arrangement of the pancreaticobiliary ductal system in 90.2% of the cases which were examined extensively. The serum amylase level was elevated in 26.6% of the cases. Calculus disease of the biliary duct was recognized in 28.5% of the cases. Biliary carcinoma developed in 54 (8.4%) of 645 cases. The incidences of biliary carcinoma were 0.3% (1/306) in cases in children and 15.6% (53/339) in adult cases; carcinoma was found in the wall of the choledochus in 30, and in the gallbladder in 16 of these 54 cases. The nationwide survey showed that an anomalous arrangement of the pancreaticobiliary ductal system was closely associated with choledochal cyst and that cases of biliary carcinoma developed with the advance of age. Therefore, early resection of the cyst wall and reconstruction of the biliary duct is proposed as suitable surgical treatment for stopping reflux of pancreatic juice into the biliary duct.
{"title":"Nationwide survey of cases of choledochal cyst. Analysis of coexistent anomalies, complications and surgical treatment in 645 cases.","authors":"N Komi, T Tamura, Y Miyoshi, K Kunitomo, H Udaka, H Takehara","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A nationwide survey of cases of choledochal cyst was conducted to obtain the data on cases of choledochal cyst in Japan between 1972 and 1982. A total of 645 cases in 73 institutions, including 52 cases from this hospital, were surveyed. Choledochal cyst was associated with an anomalous arrangement of the pancreaticobiliary ductal system in 90.2% of the cases which were examined extensively. The serum amylase level was elevated in 26.6% of the cases. Calculus disease of the biliary duct was recognized in 28.5% of the cases. Biliary carcinoma developed in 54 (8.4%) of 645 cases. The incidences of biliary carcinoma were 0.3% (1/306) in cases in children and 15.6% (53/339) in adult cases; carcinoma was found in the wall of the choledochus in 30, and in the gallbladder in 16 of these 54 cases. The nationwide survey showed that an anomalous arrangement of the pancreaticobiliary ductal system was closely associated with choledochal cyst and that cases of biliary carcinoma developed with the advance of age. Therefore, early resection of the cyst wall and reconstruction of the biliary duct is proposed as suitable surgical treatment for stopping reflux of pancreatic juice into the biliary duct.</p>","PeriodicalId":79268,"journal":{"name":"Surgical gastroenterology","volume":"3 2","pages":"69-73"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"17152540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A M Hoare, I A Donovan, M R Keighley, H Thompson, N J Dorricott, J Alexander-Williams
71 patients participated in a double-blind trial which compared proximal gastric vagotomy (PVG) with vagotomy and antrectomy (V & A). 82 percent of the patients subsequently volunteered for endoscopy 6 to 12 months after operation and 65 percent for measurement of fasting bile reflux (FBR) and peak acid output (PAO). The results of these follow-up assessments are given in this paper. None of the 36 patients who had undergone V & A had a recurrent ulcer; in contrast ulcers or fresh scars were found in 5 of 35 patients after PGV, even in 2 who had no symptoms. Erythema of the gastric mucosa was seen more commonly after V & A than PGV. Such erythema was associated with high levels of fasting bile reflux (an objective measure of reflux of bile into the stomach) and with symptoms of bile vomiting and mild epigastric pain. High levels of fasting bile reflux were not found after PGV. Histological gastritis of the proximal stomach was equally common after both operations in patients without a recurrent ulcer. Gastritis was not related to endoscopic mucosal erythema or fasting bile reflux, but did correlate with peak acid output. These results confirm that bile reflux is associated with mucosal erythema and symptoms after V & A but that significant bile reflux does not occur after PGV. However, bile reflux is not related to gastritis, which appears to be the result of an operation (either PGV or V & A) which successfully reduces peak acid output.
{"title":"A prospective randomized study of effect of proximal gastric vagotomy and vagotomy and antrectomy on bile reflux, endoscopic mucosal abnormalities and gastritis.","authors":"A M Hoare, I A Donovan, M R Keighley, H Thompson, N J Dorricott, J Alexander-Williams","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>71 patients participated in a double-blind trial which compared proximal gastric vagotomy (PVG) with vagotomy and antrectomy (V & A). 82 percent of the patients subsequently volunteered for endoscopy 6 to 12 months after operation and 65 percent for measurement of fasting bile reflux (FBR) and peak acid output (PAO). The results of these follow-up assessments are given in this paper. None of the 36 patients who had undergone V & A had a recurrent ulcer; in contrast ulcers or fresh scars were found in 5 of 35 patients after PGV, even in 2 who had no symptoms. Erythema of the gastric mucosa was seen more commonly after V & A than PGV. Such erythema was associated with high levels of fasting bile reflux (an objective measure of reflux of bile into the stomach) and with symptoms of bile vomiting and mild epigastric pain. High levels of fasting bile reflux were not found after PGV. Histological gastritis of the proximal stomach was equally common after both operations in patients without a recurrent ulcer. Gastritis was not related to endoscopic mucosal erythema or fasting bile reflux, but did correlate with peak acid output. These results confirm that bile reflux is associated with mucosal erythema and symptoms after V & A but that significant bile reflux does not occur after PGV. However, bile reflux is not related to gastritis, which appears to be the result of an operation (either PGV or V & A) which successfully reduces peak acid output.</p>","PeriodicalId":79268,"journal":{"name":"Surgical gastroenterology","volume":"3 2","pages":"54-9"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"17460723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The effects of pyloroplasty and vagal denervation of the distal stomach on gastric emptying of 10% dextrose have been compared. In a randomized trial, 38 male patients having elective surgery were treated by proximal gastric vagotomy (PGV, N = 10), proximal gastric vagotomy and pyloroplasty (PGV + P, N = 9), total gastric vagotomy (TGV, N = 9), and total gastric vagotomy and pyloroplasty (TGV + P, N = 10). Gastric emptying was recorded using an external scanning technique before and after operation. Compared with before operation, all four procedures resulted in significantly faster emptying during ingestion of the meal (the filling phase). This is attributable to failure of receptive relaxation of the proximal stomach. The emptying phase (after ingestion of the meal) was unchanged by PGV, but was significantly altered by PGV + P, TGV, and TGV + P (Principal Component Analysis). Before operation and after PGV, emptying fitted a monoexponential curve. In contrast, after PGV + P, TGV, and TGV + P, the emptying phase fitted a double exponential curve. Emptying was precipitate initially, but slowed later, leaving a large residual volume. We conclude that, when the proximal stomach is denervated, the intact, innervated distal stomach can restore the emptying of hypertonic dextrose to normal; however, when the distal stomach is denervated or pyloroplasty has been performed emptying remains uncontrolled. Since pyloroplasty and vagal denervation have the same effect, it is concluded that the mechanism retarding the emptying of hypertonic dextrose is an active mechanism that resides in the terminal antrum or pylorus.
我们比较了幽门成形术和远端胃迷走神经去支配术对10%葡萄糖胃排空的影响。在一项随机试验中,38例择期手术的男性患者接受了胃近端迷走神经切开术(PGV, N = 10)、胃近端迷走神经切开术及幽门成形术(PGV + P, N = 9)、胃全端迷走神经切开术(TGV, N = 9)和胃全端迷走神经切开术及幽门成形术(TGV + P, N = 10)。手术前后采用外扫技术记录胃排空情况。与手术前相比,所有四种方法都显著加快了进食期间的排空(填充阶段)。这是由于近端胃的接受性松弛失败所致。排空期(进食后)未受PGV影响,但PGV + P、TGV和TGV + P(主成分分析)显著改变了排空期。术前和术后排空均呈单指数曲线。而PGV + P、TGV和TGV + P后的空期则呈双指数曲线。排空最初是沉淀,但后来缓慢,留下大量的残余体积。我们认为,当近端胃去神经支配时,完整的、神经支配的远端胃可以恢复高渗葡萄糖的排空正常;然而,当远端胃去神经或幽门成形术后,排空仍然不受控制。由于幽门成形术和迷走神经去支配具有相同的效果,因此我们认为延缓高压葡萄糖排空的机制是一种活跃的机制,这种机制存在于幽门末腔或幽门。
{"title":"The importance of the distal stomach in gastric emptying of liquids in man.","authors":"C M White, V Poxon, J Alexander-Williams","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The effects of pyloroplasty and vagal denervation of the distal stomach on gastric emptying of 10% dextrose have been compared. In a randomized trial, 38 male patients having elective surgery were treated by proximal gastric vagotomy (PGV, N = 10), proximal gastric vagotomy and pyloroplasty (PGV + P, N = 9), total gastric vagotomy (TGV, N = 9), and total gastric vagotomy and pyloroplasty (TGV + P, N = 10). Gastric emptying was recorded using an external scanning technique before and after operation. Compared with before operation, all four procedures resulted in significantly faster emptying during ingestion of the meal (the filling phase). This is attributable to failure of receptive relaxation of the proximal stomach. The emptying phase (after ingestion of the meal) was unchanged by PGV, but was significantly altered by PGV + P, TGV, and TGV + P (Principal Component Analysis). Before operation and after PGV, emptying fitted a monoexponential curve. In contrast, after PGV + P, TGV, and TGV + P, the emptying phase fitted a double exponential curve. Emptying was precipitate initially, but slowed later, leaving a large residual volume. We conclude that, when the proximal stomach is denervated, the intact, innervated distal stomach can restore the emptying of hypertonic dextrose to normal; however, when the distal stomach is denervated or pyloroplasty has been performed emptying remains uncontrolled. Since pyloroplasty and vagal denervation have the same effect, it is concluded that the mechanism retarding the emptying of hypertonic dextrose is an active mechanism that resides in the terminal antrum or pylorus.</p>","PeriodicalId":79268,"journal":{"name":"Surgical gastroenterology","volume":"3 1","pages":"13-20"},"PeriodicalIF":0.0,"publicationDate":"1984-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"17579265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}