STASIS SYNDROMES FOLLOWING GASTRIC-SURGERY - CLINICAL AND MOTILITY FEATURES OF 60 SYMPTOMATIC PATIENTS
STASIS SYNDROMES FOLLOWING GASTRIC-SURGERY - CLINICAL AND MOTILITY FEATURES OF 60 SYMPTOMATIC PATIENTS
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DOI：
10.1097/00004836-199010000-00005
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发表时间：
1990-10-01
影响因子：
2.9
通讯作者：
PHILLIPS, SF
中科院分区：
文献类型：
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作者：
FICH, A;NERI, M;PHILLIPS, SF
我们回顾了60例胃手术后因瘀血而转诊进行胃肠测压的患者的记录。恶心、呕吐、腹胀、腹痛和体重减轻是最常见的症状。其中三分之二的患者在初次手术前有明确的消化性溃疡病史；在其他患者中，手术是因为其他原因，如肥胖(5%)或反流性食管炎(8%)。12例行迷走神经干切断引流术，48例行胃大部切除胃肠吻合术：Billroth I期8例，Billroth II期11例，Roux-en-Y期29例。所有患者都有胃肠测压记录；16名患者还进行了胃排空的放射性照相测量。测量结果与健康对照组的数据进行了比较。胃测压只有在胃窦完整的组中才能评估，其特点是胃窦动力低下(p>；0.05)。胃排空研究显示早期液体排空迅速，固体排空延迟(P>；0.05)。全组空腹空肠运动以II相缺失13例，阵发性活动18例，III相异常8例。Billroth II和Roux-en-Y术后MMC III相频率显著增加。餐后，19名患者未能形成“进食模式”。在35名患者中，有11名患者的进食模式持续时间比健康对照组短；在其他患者中，餐后有类似MMC的复合体，不会中断进食模式。胃手术后有症状的患者经常出现运动障碍，这与胃淤滞的发展有关。这些生理异常可能代表术前心理生理状态的持续或加重，也可能是真正的运动障碍，如胃窦运动功能低下。其中一些异常可能在手术前就已经存在，可能是手术前上肠道症状的原因，特别是在那些没有记录的消化性溃疡疾病的患者中。Billroth II和Roux-en-Y胃切除术后缺乏肠道连续性可能是导致我们观察到的压力异常的原因。我们讨论了这些病理生理学发现的治疗意义。
We retrospectively reviewed the records of 60 patients who had been referred for gastrointestinal manometry because of stasis after gastric surgery. Nausea, vomiting, bloating, abdominal pain, and weight loss were the most common symptoms. Two thirds of these patients had a well-documented history of peptic ulcer before their initial operations; in other, surgery was performed for other reasons, such as obesity (5%) or reflux esophagitis (8%). Twelve patients had undergone truncal vagotomy and a “drainage operation” and 48 had received a partial gastrectomy with a gastroenterostomy: Billroth I (n= 8), Billroth II (n= 11), Roux-en-Y (n= 29). All patients had recordings of gastrointestinal manometry; 16 also had a scintigraphic measurement of gastric empyting. Measurements were compared with data from healthy controls. Gastric manometry, which could be assessed only in the group with an intact antrum, was characterized by antral hypomotility (p> 0.05). Gastric emptying studies showed rapid early emptying of liquids and delayed emptying of solids (both p> 0.05). In the whole group, fasting jejunal motility was characterized by absence of phase II in 13, presence of bursts of phasic activity in 18, and abnormal propagation of phase III in 8. A significantly increased frequency of phase III of MMC was noted in the patients after Billroth II and Roux-en-Y operations. Postprandially, 19 patients failed to develop a “fed pattern.” In 11 of 35 patients, the fed pattern was of shorter duration than in healthy controls; in others, there were postprandial MMC-like complexes that did not interrupt the fed pattern. Motor disturbances, which occur frequently in patients symptomatic after gastric surgery, are associated with the development of gastric stasis. These physiologic abnormalities may represent a persistence or aggravation of a preoperative psychophysiologic status, or they may be a bonafide motility disorder, such as antral hypomotility. Some of these abnormalities may have been present preoperatively and may have been the cause of the upper gut symptoms before operation, particularly in those without documented peptic ulcer disease. The lack of enteric continuity following Billroth II and Roux-en-Y gastrectomy may predispose to the manometric abnormalities we observed. We discuss the therapeutic implications of these pathophysiological findings.