The Effect Of Modified Subtotal Gastrectomy On The Bile Reflux And Gastric Function In Canines

To prevent gastric gastritis and gastric ulcer caused by duodenogastric relux after subtotal gastrectomy,modified Billroth-I anastomosis was performed in the trial.The information of bile reflux,gastric fluid pH,gastrin level and gastric emptying function after the operation was studied. The effect of the modified subtotal gastrectomy on gastric function was evaluated and the clinical application of modified method was studied according to the result of these four indexes.The main point of the modified method was a nonreturn valve as same as the check-valve was made at the anastomosis spot between gastric and duodenum,therefore redundant bile reflux was prevented.After the operation of standard Billroth-I gastrectomy,right at the anastomosis spot between gastric and duodenum,gastric mucosa was divided from seromuscular layer 1cm distal to the edge and ecstrophy,then sutured with the edge of the seromuscular layer in eight places.We sutured gastric and duodenum twice.Gastric seromuscular layer sutured consecutively with duodenum seromuscular layer.The duodenum mucous layer should be penetrated and the gastric mucosa should not.Based on the first suturation,inverting suture was performed between gastric seromuscular layer and duodenum seromuscular layer consecutively.Both of the gastric and duodenum mucous layers should not be penetrated.In the trial,30 canines were chosen from local Chongqing,8～10 kg.Thirty canines were divided on average randomly into gastrotomy group,modified group and Billroth-I group.The gastric fluid observed by gastroscopy 4 weeks after the operation,and then bile reflux information was determined.The result indicated,all of the canines in the gastrotomy group were normal,the gastric mucosal fluid was not stained yellow at all.1 canine's gastric mucosal stained yellow in modified group,and the rest of 9 canines were normal.6 canines' gastric mucosal stained yellow in Billroth-Ⅰgroup,and the rest of 4 canines were normal.The appetite of modified group and gastrotomy group recovered around 3 days after the operation.The Billroth-Ⅰgroup recovered around 5 days after the operation.Then,6 canines in Billroth-Ⅰgroup appeared depression,vomit, some of the vomits was flavo-green,hydroposia quantity increased and the symptom of squatting posture,.This kind of symptom happened to 1 canine in modified group.The gastric fluid pH will be changed by the reflux of bile.The change of the gastric fluid pH can reflect the change tendency of the bile reflux.The recovery information of gastric fluid pH among Billroth-Ⅰgroup,modified group and gastrotomy group was detected after the operation,and the results before the operation were compared with that after the operation.The result indicated, the gastric fluid pH change was stable after the operation in gastrotomy group,and had no significant change compared with pre-operative level.The pH increased significantly the 7^th day after the operation in the Billroth-Ⅰgrouop,it was still higher than the level of pre-opertion till the 30^th day.The pH increased significantly the 7^th day after the operation in the modified group too. The pH level recovered to that of pre-operation on the 21^st day after the operation.Gastrin can promote gastric peristalsis and gastric fluid secretion,which is the important index of gastric function.The result of the trial indicated the gastrin level was decreased significantly in every group on the 1^st day.The gastrin level increased regularly during the recovery period.The gastrin level of the gastrotomy group was significant higher than the modified group or the Billroth-Ⅰgroup on the 3^rd,5^th,10^th,15^th,30^th day after the operation(P＜0.05).On the 10^th day after the operation,the gastrin level of gastrotomy group had recovered nearly to the pre-operative level. But the modified group and Billroth-Ⅰgroup had not recovered to the pre-operative level on the 30^th day.Because of the nonreturn valve the same as a check-valve made at the anastomosis spot of gastric and duodenum,it needed to find out if the check-valve had the effect on the gastric emptying.The information of the gastric emptying was observed by visualization with barium meal. There were 30 canines in the trial,each of gastrotomy group,modified group and Billroth-Ⅰgroup had 10 canines.Barium meal visualization trial was performed on the 1^st day before the operation and the 8^th,10^th,15^th,30^th day after the operation.The time needed by the gastric emptying all the food was observed by x ray image.The result indicated the difference between the gastrotomy group and modified group or Billroth-I group was significant(P＜0.01).The symptom of delayed emptying just appeared on the 8^th day after the operation in gastrotomy group.The emptying rate of modified group and Billroth-I group was low on the 8^th day and the 10^th day.However,the gastric emptying time recovered to the pre-operation level on the 15^th day and 30^th day after the operation, which was not significant compared with pre-operation level.Conclusion:The modified distotal gastrectomy can prevent bile reflux redundantly based on assuring the normal function of the gastric;therefore,the complication of the bile reflux gastritic can be prevented.The canines' recovery situation in the modified group was much better than that in Billroth-I group,and the rate of the imflammation caused by bile reflux was dereased dramatically.The modified method had little impact on the gastric emptying function,the emptying time can return to normal the 15^th day after the operation.The forte of Billroth-I was remained by the modified method,which made sense to the recovery of the injured canines.