臨床外科63巻12号

2008年11月発行

特集 十二指腸病変に対する外科的アプローチ 〔外科解剖・生理〕

消化管運動における十二指腸の役割

著者： 田中雅夫¹

所属機関： ¹九州大学大学院医学研究院臨床・腫瘍外科

ページ範囲：P.1511 - P.1515

要旨：十二指腸を切除したときの消化管運動への影響はあまり認識されていないが，全胃温存膵頭十二指腸切除術（PPPD）後に胃内容停滞がみられるようになって話題となった．上部消化管には空腹期に特徴的なmigrating motor complex（MMC）と称する周期的運動サイクルがある．最も特徴的なのがそのphase Ⅲで，強い収縮波の塊を形成し，回腸末端まで伝播していく．十二指腸から分泌される消化管ホルモンであるmotilinは，空腹期に十二指腸にphase Ⅲが到達したとき血中濃度がピークを描く．十二指腸はmotilinを分泌することによって胃やそのほかの運動を協調させ増強する役目を果たしている．

参考文献

1）Traverso LW, Longmire WP, Jr：Preservation of the pylorus during pancreaticoduodenectomy. Surg Gynecol Obstet 146：959-962, 1978

2）Traverso LW, Longmire WP Jr：Preservation of the pylorus in pancreaticoduodenectomy a follow-up evaluation. Ann Surg 192：306-310, 1980

3）Tanaka M：Gastroparesis after a pylorus-preserving pancreatoduodenectomy. Surg Today 35：345-350, 2005

4）van Berge Henegouwen MI, van Gulik TM, DeWit LT, et al：Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy：an analysis of 200 consecutive patients. J Am Col Surg 185：373-379, 1997

5）Kingsnorth AN, Berg JD, Gray MR：A novel reconstructive technique for pylorus-preserving pancreaticoduodenectomy：avoidance of early postoperative gastric stasis. Ann Royal Col Surg Engl 75：38-42, 1993

6）Yamaguchi K, Tanaka M, Chijiiwa K, et al：Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hep Bil Pancr Surg 6：303-311, 1999

7）McAfee MK, van Heerden JA, Adson MA：Is proximal pancreatoduodenectomy with pyloric preservation superior to total pancreatectomy?. Surgery 105：347-351, 1989

8）Williamson RC, Bliouras N, Cooper MJ, et al：Gastric emptying and enterogastric reflux after conservative and conventional pancreatoduodenectomy. Surgery 114：82-86, 1993

9）Doberneck RC, Berndt GA：Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arch Surg 122：827-829, 1987

10）Bar-Natan M, Larson GM, Stephens G, et al：Delayed gastric emptying after gastric surgery. Am J Surg 172：24-28, 1996

11）Cohen AM, Ottinger LW：Delayed gastric emptying following gastrectomy. Ann Surg 184：689-696, 1976

12）Isobe H, Sakai H, Satoh M, et al：Delayed gastric emptying in patients with liver cirrhosis. Dig Dis Sci 39：983-987, 1994

：Daniel EE（ed）；Proceedings of the Fourth International Symposium on GI Motility. Vancouver, Mitchell Press, 1973

14）Brown JC, Cook MA, Dryburgh JR：Motilin, a gastric motor activity-stimulating polypeptide：final purification, amino acid composition, and C-terminal residues. Gastroenterology 62：401-404, 1972

15）Itoh Z, Takeuchi S, Aizawa I, et al：Changes in plasma motilin concentration and gastrointestinal contractile activity in conscious dogs. Dig Dis Sci 23：929-935, 1978

16）Itoh Z, Honda R, Hiwatashi K, et al：Motilin-induced mechanical activity in the canine alimentary tract. Scand J Gastroenterol（suppl 39） 11：93-110, 1976

17）Tanaka M, Senninger N, Runkel N, et al：Hormonal control of opossum sphincter of Oddi motility：Role of myoneural continuity to duodenum. J Surg Res 53：91-97, 1992

18）Tanaka M, Sarr M：Total duodenectomy：effect on canine gastrointestinal motility. J Surg Res 42：483-493, 1987

19）Tanaka M, Sarr M：Role of the duodenum in the control of canine gastrointestinal motility. Gastroenterology 94：622-629, 1988

20）Suzuki H, Mochiki E, Haga N, et al：Effect of duodenectomy on gastric motility and gastric hormones in dogs. Ann Surg 233：353-359, 2001

21）Naritomi G, Tanaka M, Matsunaga H, et al：Pancreatic head resection with and without preservation of the duodenum：different postoperative gastric motility. Surgery 120：831-837, 1996

22）Muller MW, Friess H, Beger HG, et al：Gastric emptying following pylorus-preserving Whipple and duodenum-preserving pancreatic head resection in patients with chronic pancreatitis. Am J Surg 173：257-263, 1997

23）Yamaguchi K, Tanaka M, Chijiiwa K, et al：Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hep Bil Pancr Surg 6：303-311, 1999

24）Ohtsuka T, Takahata S, Ohuchida J, et al：Gastric phase 3 motility after pylorus-preserving pancreatoduodenectomy. Ann Surg 235：417-423, 2002

25）Yamaguchi K, Kishinaka M, Nagai E, et al：Pancreatoduodenectomy for pancreatic head carcinoma with or without pylorus preservation. Hepato-Gastroenterol 48：1479-1485, 2001

26）Muller MW, Friess H, Beger HG, et al：Gastric emptying following pylorus-preserving Whipple and duodenum-preserving pancreatic head resection in patients with chronic pancreatitis. Am J Surg 173：257-263, 1997

27）Takeda T, Yoshida J, Tanaka M, et al：Delayed gastric emptying after BillrothⅠ pylorus-preserving pancre-atoduodenectomy. Effect of postoperative time and cisapride. Ann Surg 229：223-229, 1999

28）Matsunaga H, Tanaka M, Naritomi G, et al：Effect of leucine 13-motilin（KW5139）on early gastric stasis after pylorus-preserving pancreatoduodenectomy. Ann Surg 227：507-512, 1998

29）Yeo CJ, Barry MK, Sauter PK, et al：Erythromycin accelerates gastric emptying after pancreatoduodenec-tomy. A prospective, randomized, placebo-controlled trial. Ann Surg 218：229-237, 1993

30）Matsunaga H, Tanaka M, Takahata S, et al：Manometric evidence of improved early gastric stasis by erythromycin after pylorus-preserving pancreatoduodenec-tomy. World J Surg 24：1236-1242, 2000

31）Ohwada S, Satoh Y, Kawate S, et al：Low-dose erythromycin reduces delayed gastric emptying and improves gastric motility after BillrothⅠ pylorus-preserving pancreaticoduodenectomy. Ann Surg 234：668-674, 2001