胃冷凍이 肝排出機能에 미치는 影響

Abstract

[한글]

[영문]

After the introduction of gastric freezing for the treatment of duodenal ulcer (Wangensteen et al., 1962) by damaging the gastric secretory cells, it was hoped that their regeneration would be retarded, thus achieving diminution in gastric acid secretion. However there has been considerable controversy about this to date.

In fact, the experience of most observers has been as follows:

Although immediate symptomatic improvement is quite uniformely attained, the duration of such relief is variable and unpredictable (Rose et al., 1964, Scott et al., 1964 and Artz et al., 1964) ;

Whereas significant reduction in gastric acid secretion is often observed initially, most patients experience a return of acid secretion to prefreeze levels within 3-6 months (Rose et al., 1964, and Bernstein et al., 1964).

Current technics if clinical gastric freezing produce only a patchy freeze of incomplete distribution and isolated areas of overfreeze leading to necrosis may occur (Arts et al., 1964, Bernstein et al., 1964 and White et al., 1964).

These observations have considerably dampened earlier enthusiasm for gastric freezing.

Brauer (1956), on the other hand, reported dramatic reduction in bile flow rate and falling off of BSP extraction efficiency with retardation of BSP excretion in the isolated rat liver perfused with low temperatures. He also observed the phenomenon of overshooting of bile flow on rewarming.

S.L. Wangensteen et al. (1961) reported 35% reduction in hepatic plasma flow, and O.H. Wangensteen et al. (1959) reported 66% reduction in gastric blood flow, during gastric colling respectively. Since arterial blood supply to stomach and the liver stem from the same source, it was suggested that gastric cooling and also gastric freezing might result in a reduction in heaptic arterial blood flow.

On the basis of these considerations, this investegation was designed to study excretory function of the liver during gastric freezing in 15 adult mongrel dogs of both sexes.

The technique of gastric freezing was performed with the Swenko Gastric Hypothermia Machine as described by Wangensteen et al. (1962).

The result may be summarized as follows;

1. The average rectal temperature before gastric freezing was 37.8℃., and fell progressively during this procedure and was 29.8℃. At the end of gastric freezing.

2. Hepatic bile flow rates diminished significantly during gastric freezing, and recovery of flow rates was observed on rewarming.

3. Na and K ion concentration of hepatic bile showed no significant changes during gastric freezing, but there was slight reduction in Cl and slight rise in HCO^^3 ion concentration during gastric freezing, and HCO^^3 ion concentration approached prefreeze values on rewarming.

4. Serum alkaline phosphatase activity and cholesterol values remained unchanged during gastric freezing.

5. BSP tests performed during and after gastric freezing revealed significant abnormal retention of dye in the blood in both groups.