Clinical Gastric Motility Studies on Patients following Pylorus Preserving Pancreatoduodenectomy

Fasting and postprandial gastric motility was examined using a microtransducer catheter in 7 patients during the acute state following pylorus preserving pancreatoduodenectomy(PPPD), 8 patients during recovery after PPPD, 7 patients during chronic state after PPPD and 5 healthy volunteers. During fasting, abnormal contraction(cluster),defined as phasic waves with an amplitude >20mmHg and duration of about 2 minutes after PPPD, was noted. Phase III tended to appear more in the chronic state than in the recovery state. Vagus nerve pyloric branches and the right gastric artery were found not to be involved in cluster appearance or phase III. The gastric motility index during fasting for the above situations was essentially the same. Regarding phase III appearing after PPPD, acomparison with the healthy subjects indicated the time for recovery state to be longer, but that of appearance to be the same phase III in the chronic state was the same in all cases. In the postprandial stage, the duration of feeding among subjects in the recovery and chronic states and volunteers was the same. Three of 8 patients with delayed gastric emptying during recovery underwent reconstruction of Billroth II type, and phase III was found not to occur completely based on internal pressure data. Abnormal contraction or cluster contraction thus occurs for a long period after PPPD. Abnormality of interdigestive gastric motility with the absence of phase III may possibly be a factor for reduction in gastric content after PPPD.

全胃幽門輪温存膵頭十二指腸切除

胃運動

胃内圧

胃内容停滞