保留迷走神经主干的贲门周围血管离断术治疗门静脉高压症临床体会

目的 :探讨保留迷走神经主干的贲门周围血管离断术 (VTPPD)比较于切断迷走神经主干的贲门周围血管离断术加幽门成形术 (PD+PP)治疗门脉高压症的治疗效果。方法 :回顾性分析 1999— 10～ 2 0 0 3— 0 5实施的 VTPPD31例与 PD+PP4 8例 ,比较两组病人手术并发症 ,死亡率。结果 :VTPPD组手术死亡率为 9.7% ,PD+PP组手术死亡率为 12 .5 % ,两者死亡率无明显差异 (P >0 .0 5 ) ;VTPPD组并发症明显低于 PD+PP组 (P <0 .0 1)。结论 :保留迷走神经主干的贲门周围血管离断术能够降低术后并发症 ,提高门脉高压症手术的远期疗效。     

脾切加贲门周围血管离断术的临床护理体会

肝硬化引起门脉高压症,导致食管胃底静脉破裂出血是一种临床急症,脾切加贲门周围血管离断术是防止再出血的有效措施,围手术期做好临床护理工作是减少术后并发症的重要措施。我科从2005年6月到2009年10月共为肝硬化门脉高压症患者实施脾切加贲门周围血管离断术26例,通过     

肝硬化门脉高压症合并胆结石的外科手术疗效观察

目的对肝硬化门脉高压症合并胆结石患者采取不同的外科手术处理方式,以对其疗效作出评估,找出较为优秀的治疗方案。方法选取我院从2005年2月到2008年3月的肝硬化门脉高压症患者合并胆结石患者20例作为研究对象,将所有患者分为1～4组四个组,每组5例。1组患者采取一期脾切除、胆囊切除术和贲门周围血管离断术;2组患者采取分期脾切除、胆囊切除术和贲门周围血管离断术;3组患者采取贲门周围血管离断术和中西医利胆治疗;4组患者行单纯脾切除和贲门周围血管离断术治疗。察各组患者的食管胃底静脉曲张消除率、肝功能改善率和再出血的情况。结果经过两年随访后发现,与单纯进行脾切除和离断术的4组相比,合并治疗胆结石的1、2、3组在肝功能改善率和再出血情况中都较为优异,其差异有统计学意义(P<0.05);而在食管胃底静脉曲张消除率方面四组的差异均无统计学意义(P>0.05)。结论上述四种手术对该病都有着确切的疗效,但采取脾切除、贲门周围血管离断术并对胆结石治疗肝硬化门脉高压症合并胆结石的疗效优于单纯行脾切除、贲门周围血管离断术,能改善患者的肝功能和降低再出血的可能性,从而增强患者的生活质量,因此推荐在今后临床治疗中选择性选择该法。     

保留迷走神经选择性贲门周围血管离断术治疗门静脉高压症临床分析

<正>传统的贲门周围血管离断术切断了冠状静脉,破坏了食管旁静脉,阻断了门奇静脉间的自发性分流,使门静脉压下降不明显;同时该手术切断了迷走神经主干,使消化系统神经调节功能遭到破坏,影响了胃肠道的正常生理活动。我科近期采用了保留迷走神经选择性贲门周围血管离断术,取得较好临床疗效,现报告如下。     

腹腔镜脾切除加贲门周围血管离断术诊治体会

目的探讨腹腔镜脾切除加贲门周围血管离断术的可行性和安全性。方法对16例门脉高压症并食管胃底静脉曲张患者施行手助腹腔镜脾切除加贲门周围血管离断术。结果所有患者均行脾切除加贲门周围血管离断术治疗,手术过程顺利,无中转开腹手术。完成切除共用4．5—5h。术后患者恢复顺利,术后行抗感染、护肝、利尿、降门脉高压及抗Hp治疗。无近期再次出血、无膈下感染等并发症发生。结论腹腔镜脾切除加贲门周围血管离断术不仅安全有效可行,而且具有微创手术的优点。     

血行阻断术治疗门静脉高压症

我院采用血行阻断术(即脾切加贲门周围血管离断加粘膜外胃底横断与幽门成形),治疗21例门脉高压症病人。其中食管胃底曲张静脉破裂大出血急诊手术7例,死亡2例,择期手术14例,死亡1例。通过手术前后门静脉压与食管静脉曲张的变化与短期的随诊效果,疗效尚满意。该术式的要点是彻底切断胃小     

贲门周围血管离断术治疗肝硬化门脉高压并上消化道出血的分析

目的总结和分析贲门周围血管离断术对肝硬化门脉高压并上消化道出血的疗效。方法分析柘城县人民医院自2005年1月—2010年1月间30例肝硬化门脉高压并上消化道出血患者采用贲门血管离断术的资料,探讨其疗效。结果经过6个月到5年随访,3例复发上消化道出血,死亡4例,死于肝功能衰竭,其余病例经治疗后恢复良好。结论贲门周围血管离断术治疗肝硬化门脉高压并上消化道出血效果好。为提高手术疗效,应合理掌握手术适应证及手术时机,彻底断流,熟练掌握手术的技术要点,防止并发症的发生。     

脾切除加贲门周围血管离断术与普萘洛尔联合治疗门脉高压性食管胃底静脉曲张95例

我院自1997年8月至2006年8月共收治肝硬化门脉高压症120例，其中95例并发食管胃底静脉曲张，采用脾切除、贲门周围血管离断术，围术期服用普萘洛尔（心得安）治疗，取得良好效果。现总结如下：     

手助下腹腔镜脾切除贲门周围血管离断术治疗门脉高压症脾功能亢进、食管及胃底静脉曲张破裂出血

目的为减轻手术对肝硬化门脉高压症病人创伤,减少术中出血,保护肝脏功能,减少并发症的发生,采用手助下腹腔镜微创技术进行脾切除、贲门周围血管离术,治疗门脉高压症脾功能亢进、食管及胃底静脉曲张破裂出血。方法右侧卧位,内镜置于脐部,左手经上腹左侧约7cm长的经腹直肌切口伸入腹腔,左肋弓下腋前线置10cm Trocar,经此操做孔应用超声刀、ligasure等各种器械与左手配合完成脾切除及门奇断流术。结果本组35例,脾切除加贲门周围血管离断术33例,脾切除加胆囊切除2例,术后切口液化3例,腹水12例。结论应用手助腹腔镜技术行脾切除、贲门周围血管离断术,缩短了腹壁切口长度,开阔了食管、胃底、脾上极深在部位的视野,方便操作,腹腔干扰轻,出血少,是一种非常可取的手术方法。     

门静脉高压症围手术期的护理

门静脉高压症行脾切除加贲门周围血管离断术是临床上治疗各种原因肝硬化合并食管胃底静脉曲张破裂出血及脾肿大、脾功能亢进的一种有效方法。由于该类患者一般情况差,对围手术期的护理要求高。     

A comparative study on gastric emptying and secretory status in the early postoperative period after truncal vagotomy with two pyloroplasty variants performed for peptic ulcer disease. II. Heineke-Mikulicz pyloroplasty and comparison with the cassimally routine

In 14 peptic ulcer patients undergoing truncal vagotomy with Heineke-Mikulicz pyloroplasty (VTP-HM), gastric emptying of a radiolabeled solid meal, gastric acid secretion and gastrin release was examined within a median of 14 days (range; 10 to 63 days) following the operation, and compared with the results obtained in 14 patients subjected to vagotomy and Cassimally pyloroplasty (VTP-Cas). VTP-HM markedly disturbed gastric emptying in 10 out of 14 patients (71%), four of which (28%) had extremely rapid, and six (43%) exhibited abnormally delayed gastric emptying. Due to a wide inter-subject variability, no significant differences between VTP-HM and VTP-Cas were found for any of the gastric emptying parameters considered. The basal acid output was significantly lower after VTP-Cas than VTP-HM: 2.4 +/- 0.8 vs 5.8 +/- 1.0mmol.h-1, (p less than 0.02). The difference in pentagastrin-stimulated gastric acid secretion: 9.4 +/- 1.4 vs 12.0 +/- 1.8 mmol.h-1 for VTP-Cas vs VTP-HM, respectively, was not statistically significant. Higher fasting serum gastrin concentration (102.0 +/- 21.1 vs 63.3 +/- 8.3 ng.l-1), and greater postprandial gastrin release (AUC0-120: 16690 +/- 2648 vs 10654 +/- 1283 ng.l-1 min) were observed after VTP-HM than after VTP-Cas. The respective differences did not, however, reach the level of statistical significance, the possible clinical relevance of the differences between the two pyloroplasty procedures with respect to their effect on gastric evacuatory and secretory functions is discussed.     

The effect of intravenous erythromycin on solid meal gastric emptying in patients with chronic symptomatic post-vagotomy–antrectomy gastroparesis

Background : Chronic symptomatic gastroparesis occurs in 3–5% of patients following vagotomy and antrectomy. Erythromycin, a macrolide antibiotic, improves gastric emptying in patients with idiopathic and diabetic gastroparesis. Erythromycin's effect on gastric emptying in patients with post-vagotomy– antrectomy gastroparesis is unknown. The aim of this study was to determine if a single dose of intravenous erythromycin (1 mg/kg or 6 mg/kg) accelerates solid meal gastric emptying in patients with chronic symptomatic post-vagotomy–antrectomy gastroparesis.
Methods : Six patients were entered into the study, three males and three females, with a mean age of 50 years. Four patients were randomized to receive erythromycin 6 mg/kg and two patients 1 mg/kg. The mean time since initial surgery was 9.2 years (range 1–16 years) with five patients having undergone a Roux-en-Y revision.
Results : Intravenous erythromycin significantly lowered percentage gastric retention at 120 min, from a baseline of 90.5±6% (S.E.M.) to 40.1±4.8% after erythromycin ( P =0.0002). Erythromycin improved gastric emptying in each patient by at least 40%. Intravenous erythromycin significantly accelerated the rate of gastric emptying in the first 30 min after meal ingestion from a baseline rate of 0.072±0.06%/min to 0.96±0.31%/min after erythromycin ( P =0.028). For each of the subsequent 30 minute time periods, erythromycin had no significant effect on the rate of gastric emptying.
Conclusion : Intravenous erythromycin significantly improves the initial phase of solid meal gastric emptying in patients with chronic symptomatic post-antrectomy–vagotomy gastroparesis.     

Pituitary-adrenal and vagus modulation of sauvagine- and CRF-induced inhibition of gastric emptying in rats

Sauvagine and CRF significantly delayed gastric emptying in rats: sauvagine was 21 times more potent than CRF in inhibiting gastric emptying when injected subcutaneously and 59 times more potent when injected intracerebroventricularly. The inhibitory effect of intracerebroventricular and subcutaneous injections of sauvagine and CRF was always reversed by vagotomy. Hypophysectomy significantly reduced the inhibitory effect of subcutaneously injected sauvagine and CRF, but not that of intracerebroventricularly injected peptides. Adrenalectomy completely prevented the inhibition of gastric emptying only if it was performed 7 days before peptide administration, whereas the central and peripheral inhibitory effect of sauvagine and CRF was retained after acute (1 h) adrenalectomy. In animals adrenalectomized 7 days previously, chronic administration or a single dose of corticosterone at different intervals (1, 24 and 72 h) before the test caused the peptides to recover their inhibitory activity. These results demonstrate that the inhibitory action of sauvagine and CRF clearly depends on the integrity of the parasympathetic nervous system (vagus), and on corticosterone secretion by the adrenal gland.     

胃部分切除手术治疗早期胃癌的疗效分析

目的探讨保留幽门与迷走神经的胃部分切除术治疗早期胃癌的临床价值。方法选取本院2009年3月-2010年3月本院普通外科收治的早期胃癌患者140例,根据临床术式不同分为观察组与对照组各70例,对照组行远端胃切除术,观察组行保留迷走神经与幽门的胃部分切除术,对比两组的临床疗效。结果观察组患者服药15、30、60min的胃排空功能相比对照组均显著改善（P〈0．05）;胆囊收缩功能仅在60min后明显高于对照组（P〈O．05）,15min与30min两组相比差异无统计学意义（P〉0．05）。两组3年的生存率与胃癌复发率相比差异无统计学意义（P〉0．05）。结论保留幽门与迷走神经的胃部分切除术治疗早期胃癌能够有效改善患者术后胃排空与胆囊收缩功能,且术后BMI指数明显提升,是胃癌早期手术中临床价值较高的术式。     

Effect of the motilin agonist KC 11458 on gastric emptying in diabetic gastroparesis

BACKGROUND: KC 11458, a motilin agonist without antibiotic properties, accelerates gastric emptying in animals and healthy humans. AIM: To evaluate the acute effects of KC 11458 on gastric emptying in diabetic gastroparesis. METHODS: Twenty-nine patients (6 type 1 and 23 type 2) with gastroparesis underwent assessments of: (i) gastric emptying of a solid/liquid meal using scintigraphy, (ii) glycaemic control (blood glucose at 0, 30, 60, 90 and 120 min during the gastric emptying measurement) and (iii) upper gastrointestinal and 'meal-related' symptoms (questionnaire), at baseline and after treatment with KC 11458 in a dose of 8 mg t.d.s., or placebo for 8 days. RESULTS: KC 11458 had no statistically significant or clinically relevant effect on gastric emptying of either the solid intragastric retention at 100 min (T100) (P = 0.87) or liquid 50% emptying time (T50) (P = 0.17) components of the meal. KC 11458 slightly worsened (P = 0.04) upper gastrointestinal symptoms when compared with placebo. The magnitude of the change in solid gastric emptying correlated with the change in the blood glucose concentration (r = 0.49; P < 0.05). CONCLUSIONS: KC 11458, in a dose of 8 mg t.d.s. for 8 days, does not accelerate gastric emptying in patients with diabetic gastroparesis. The absence of efficacy may relate to an effect of hyperglycaemia.     

A comparative study on gastric emptying and secretory status in the early postoperative period after truncal vagotomy with two pyloroplasty variants performed for peptic ulcer disease. I. Cassimally pyloroplasty

Gastric emptying (GE) of a radiolabeled solid meal, gastric acid secretion and gastrin release were examined within a median of 15.5 days (range: 9 to 66) after surgery in 14 peptic ulcer patients subjected to truncal vagotomy with Cassimally pyloroplasty (VTP-Cas). A significant delay in GE was observed after VTP-Cas; the median slope of GE curves, K, decreased from 14.65 (range: 2.56 to 21.86) before to 4.05 (range: 0 to 11.67) min-1.10-3 after the operation (p less than 0.002). The postoperative GE was significantly slower than in a group of 41 healthy controls (median K = 9.09, range: 3.72 to 28.66 min-1.10(-3), p less than 0.01 vs the VTP-Cas-operated patients), and was characterized by a biphasic pattern with a slowed second phase. VTP-Cas resulted in a reduction of the basal acid secretion by an average of 87% (from 9.5 +/- 3.4 to 1.2 +/- 0.2 mmol.h-1, p less than 0.05), and the pentagastrin-stimulated acid output by 72% (from 30.8 +/- 7.2 to 8.6 +/- 1.6 mmol.h-1, p less than 0.05). The fasting serum gastrin concentration remained unchanged after VTP-Cas (68.2 +/- 10.8 pre- vs 67.3 +/- 9.4 ng.1-1 post-operatively), whereas a slight and statistically insignificant increase in the meal-induced gastrin release was found following the VTP-Cas-AUC0-120: 10002 +/- 1298 pre- vs 11234 +/- 1422 ng.1-1 min postoperatively.     

Effect of experimental diabetes and vagotomy on gastric emptying in rats

The present study was performed to evaluate the rate of whole stomach emptying (WSE) in streptozotocin (STZ) induced rat model of diabetes mellitus by assessing the effect of bilateral gastric vagotomy in control as well as in experimental animals. Our results revealed that delayed emptying of solid foods by the stomach is demonstrated within 5 days of induction of diabetes in rats. After bilateral vagotomy, the later stages of WSE slowed down because of the diabetic state, most probably due to the direct effect of diabetes on the gastric antrum.     

The Vagus Nerve and its Non-cholinergic Mechanism in the Modulation of Ethanol-induced Gastric Mucosal Damage in Rats

Abstract— The role of the cholinergic pathway in the vagus nerve in modulating gastric lesion formation by ethanol was examined, using an ex-vivo stomach chamber preparation. Subdiaphragmatic vagotomy significantly increased the lesion areas but lowered acid secretion and gastric mucosal blood flow (GMBF). Atropine had no effect, whereas pirenzepine antagonized ethanol-induced mucosal damage. All three procedures showed similar potencies in depressing acid secretion, but only pirenzepine reversed the fall in the GMBF produced by ethanol. These differential effects of vagotomy, atropine and pirenzepine on gastric function suggest that the cholinergic component in the vagus nerve may not be important in the formation of ethanol-induced gastric damage. The persistent protective action as well as the restoration of ethanolinduced GMBF drop by pirenzepine in vagotomized animals further support this hypothesis. The worsening effect of vagotomy is probably modulated by a non-cholinergic mechanism, the abolition of which makes the gastric mucosa more susceptible to damage by ethanol. The acid-independent protective action of pirenzepine and its influence on the GMBF, which were not exhibited by atropine, are indeed unique and perhaps may be attributed to this non-cholinergic pathway.     

食管癌术后胃排空障碍的分析

目的:探讨食管上中段癌切除食管胃颈部吻合术后胃排空障碍的原因。方法:对57例食管上、中段癌病人临床资料进行回顾性分析。结果:功能性胃排空障碍3例(5.26%),机械性胃排空障1例(1.75%)。结论:胃排空障碍多为功能性,少数为机械性,功能性胃排空障碍主要与迷走神经干的切断及胃解剖位置的变化有关,机械性胃排空障碍主要与手术操作有关。     

Modulation of gastric contractions in response to tachykinins and bethanechol by extrinsic nerves.

1. Extrinsic reflexes elicited by changes in gastric wall tension play an important role in regulating gastric tone. The present study investigated whether such reflexes modulate gastric contractions induced by close arterially administered neurokinin A (NKA), substance P (SP), SP-methylester and bethancehol in anaesthetized rats. 2. Reflex pathways were acutely interrupted by either subdiaphragmatic vagotomy or prevertebral ganglionectomy. C-fibre afferent nerve activity was abolished by pretreating rats with capsaicin 10 to 16 days before the experiments. 3. The order of potency in inducing gastric contractions was NKA greater than SP greater than bethanechol. SP-methylester was markedly less effective than SP and its effects did not fit sigmoid dose-response curves (DRCs). The maximal responses to NKA, SP, and bethanechol were similar, whilst the DRC for SP was significantly flatter than those for NKA or bethanechol. Pretreatment of the rats with the peptidase inhibitors phosphoramidon or captopril did not increase the contractile response to SP. 4. Prevertebral ganglionectomy had no significant effect on the DRCs for SP and NKA, whereas vagotomy shifted the DRCs for all three test substances to the left. 5. Capsaicin pretreatment did not change the DRC for NKA in rats with intact vagus but shifted that for bethanechol to the left. The leftward of the DRC for NKA caused by vagotomy was prevented in capsaicin-pretreated rats whereas the vagotomy-induced shift of the DRC for bethanechol remained unaltered. The shift of the DRC for SP seen in response to vagotomy was only slightly reduced by capsaicin pretreatment. 6. These data may be interpreted as demonstrating two neuronal mechanisms for modulating drug-induced gastric contractions.(ABSTRACT TRUNCATED AT 250 WORDS)