선택적미주신경절단술 및 유문성형술과 벽세포미주신경절단술후 Insulin 랄극이 위산분비에 미치는 영향에 관한 실험적 연구

초록

Parietal cell vagotomy without drainage is being performed with increasing frequency for the treatment of duodenal ulcer because of low frequency of postoperative complications. One of the early parameters of operation for duodenal ulcer is reduction in acid secretion. Parietal cell vagotomy without drainage was compared with selective vagotomy and Heineke-Miculicz pyloroplasty in order to evaluate the superiority to reduce gastric acid secretion. Author carried out the experiment on the gastric secretory response to insulin (0.5 unit/㎏) in total 18 mongrel dogs, (8 gastrostomy dogs, 5 parietal cell vagotomy dogs, and 5 selective vagotomy with pyloroplasty dogs). Insulin was given in all dogs at 1 month interval from 1st, 2nd and up to 3rd month. Each time after injection of insulin, gastric juice was obtained 8 times at 15 minute intervals for the measurement of free acidity. The results were as follows: 1. The reduction rates of free acidities of 1 month, 2 month and 3 month after parietal cell vagotomy (40.74±, 70.37% and 56.67% respectively) were greater than those after selective vogotomy with pyloroplasty (18.52%, 41.27%, and 25.93% respectively). 2. The reduction rates of insulin responded free acidities of 1 month, 2 month and 3 month after parietal cell vagotomy (76.74%, 64.16% and 40.53% respectively) were greater than those after selective vagotomy with pyloroplasty(40.50%, 53.73% and 23.49% respectively). 3. No difference in Hollander tests was found in both operations. In 1 month, 2 month after both operations, Hollander tests were negative respectively, but in 3 month after both operations, Hollander tests were late positive respectively. 4. The values of serum gastrin of 3 month after both operations were 52.72pg/ml, and 62.2pg/ml, which showed marked increase as compared with control group, 26.01pg/mal. Serum gastrin value on parietal cell vagotomy was slightly less that on selective vagotomy with pyloroplasty, but no significant difference was found. 5. It was concluded that parietal cell vagotomy was superior to selective vagotomy with pyloroplasty in view of gastric acid secretion.

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