Mudanças na vascularização arterial da curvatura menor do estômago após gastrectomia segmentar associada à vagotomia gástrica proximal em cães

Watanabe, Luís Massaro; Andrade, José Ivan de; Sala, Miguel Angel; Ghilardi Netto, Thomaz; Ceneviva, Reginaldo

doi:10.1590/S0100-69911998000400002

Resumos

Para avaliar os efeitos da gastrectomia segmentar do corpo associada à vagotomia gástrica proximal (GS + VGP), sobre a vascularização arterial da curvatura menor do estômago, foram utilizados 24 cães distribuídos em dois grupos de 12 animais, com as seguintes denominações: Grupo I, animais submetidos à laparotomia e manipulação gástrica; Grupo II, animais submetidos à GS + VGP. Em cada grupo, metade dos animais foi sacrificada no terceiro, metade no oitavo dia pós- operatório. No dia do sacrifício, procedeu-se à injeção de mistura de bário-gelatina, na vascularização arterial do estômago. A seguir, o estômago foi removido do animal, fixado em solução de formol, aberto pela curvatura maior e radiografado com técnica padronizada. A intensidade da vascularização da curvatura menor do estômago foi determinada por microdensitometria e morfometria. Pela microdensitometria, foram determinados os valores de densidade óptica, convertidos em equivalentes de milímetros de alumínio, da imagem radiográfica da curvatura menor do estômago. Com base nesses resultados, verificou-se que os valores médios de densidade óptica do grupo II foram significativamente maiores do que o grupo I (p<0,001). Pelo estudo morfométrico de fragmento histológico da curvatura menor, observou-se que os valores médios de volume relativo das arteríolas, em relação ao volume total da camada submucosa, foram significativamente maiores no grupo II em comparação ao grupo I (p<0,001). Os valores médios dos diâmetros das arteríolas da camada submucosa foram significativamente mais elevados no grupo II que no grupo I (p<0,001). O número de arteríolas por mm2 da camada submucosa não diferiu significativamente entre os dois grupos (p>0,05). Embora a execução da GS + VGP implique desvascularização da curvatura menor do estômago, observou-se aumento da intensidade da vascularização arterial desta curvatura nos animais do grupo II, conseqüente à dilatação das arteríolas da camada submucosa.

Gastrectomia segmentar; Vagotomia gástrica proximal; Vascularização da curvatura menor

In order to evaluate the possible effects determined by combined body segmental gastrectomy and proximal gastric vagotomy on the arterial vascularization of the lesser curvature of the stomach, twenty-four dogs. weighing 10 to 20 kg, were divided into two groups of 12 animals each: Group 1, animals were submitted to laparotomy and gastric manipulation for 30 minutes; Group II, animals were submitted to segmental gastrectomy with proximal gastric vagotomy. In each group, six animals were sacrificed on the third postoperative day and six on the eighth postoperative day. Neither death nor other postoperative complications occurred. On the sacrifice day barium-gelatin contrast was injected into the arterial vascularization of the stomach, which was then removed from the animal, opened along the greater curvature, fixed in formalin and submitted to radiographs. The intensity of the vascularization of the lesser curvature of the stomach was determined by microdensitometric and molphometric study. By means of microdensitometry. values of the optical densities were determined of the radiograph image of the lesser curvature of the stomach. Considering the microspectrophotometry principies. the values of the optical densities converted in aluminum equivalent were directly proportional to the intensity of vascularization of the gastric lesser curvature. The analysis of the obtained microdensitometry data revealed mean values of optical densities significantly more intense in group 11, when compared to group 1 (p<0.001). On the basis of the morphometric study of the histologic fragment of the lesser curvature, it was observed that: a) the mean arteriole volumes, relative to total submucosa volumes, were significantly greater in group 11 than in group 1 (p<0.001); b) the mean values of the arterioles diameter of the submucosal of group 11 were significantly larger than in the group 1 (p<0.001); c) there was no change in the number of arterioles per mm2 of the submucosal between the two groups (p>0.05). Therefore. it was found an increased intensity of the arterial vascularization of the lesser. The increased vascularization was consequence of arteriole dilatation of the submucosal layer.

Segmental gastrectomy; PGV; Vascularization of the lesser curvature

ARTIGOS ORIGINAIS

Mudanças na vascularização arterial da curvatura menor do estômago após gastrectomia segmentar associada à vagotomia gástrica proximal em cães

The arterial vascularization changes of the lesser curvature of the stomach after segmental gastrectomy and proximal gastric vagotomy in dogs

Luís Massaro Watanabe, TCBC.DF^I; José Ivan de Andrade, TCBC-SP^II; Miguel Angel Sala^III; Thomaz Ghilardi Netto^IV; Reginaldo Ceneviva, TCBC-SP^V

^IProfessor Adjunto do Departamento de Cirurgia da Faculdade de Ciências da Saúde da Universidade de Brasília

^IIProfessor Doutor da Disciplina de Gastroenterologia Cirúrgica da FMRP-USP

^IIIProfessor Titular do Departamento de Estomatologia da FORP-USP

^IVProfessor Associado do Centro de Instrumentação, Dosimetria e Radioproteção da FFCLRP-USP

^VProfessor Titular do Departamento de Cirurgia, Ortopedia e Traumatologia da FMRP-USP

^{Endereço para correspondência} Endereço para correspondência: Dr. Luís Massaro Watanabe SQN 316 Bloco A Apto. 102 70775-010- Brasília - DF

RESUMO

Para avaliar os efeitos da gastrectomia segmentar do corpo associada à vagotomia gástrica proximal (GS + VGP), sobre a vascularização arterial da curvatura menor do estômago, foram utilizados 24 cães distribuídos em dois grupos de 12 animais, com as seguintes denominações: Grupo I, animais submetidos à laparotomia e manipulação gástrica; Grupo II, animais submetidos à GS + VGP. Em cada grupo, metade dos animais foi sacrificada no terceiro, metade no oitavo dia pós- operatório. No dia do sacrifício, procedeu-se à injeção de mistura de bário-gelatina, na vascularização arterial do estômago. A seguir, o estômago foi removido do animal, fixado em solução de formol, aberto pela curvatura maior e radiografado com técnica padronizada. A intensidade da vascularização da curvatura menor do estômago foi determinada por microdensitometria e morfometria. Pela microdensitometria, foram determinados os valores de densidade óptica, convertidos em equivalentes de milímetros de alumínio, da imagem radiográfica da curvatura menor do estômago. Com base nesses resultados, verificou-se que os valores médios de densidade óptica do grupo II foram significativamente maiores do que o grupo I (p<0,001). Pelo estudo morfométrico de fragmento histológico da curvatura menor, observou-se que os valores médios de volume relativo das arteríolas, em relação ao volume total da camada submucosa, foram significativamente maiores no grupo II em comparação ao grupo I (p<0,001). Os valores médios dos diâmetros das arteríolas da camada submucosa foram significativamente mais elevados no grupo II que no grupo I (p<0,001). O número de arteríolas por mm2 da camada submucosa não diferiu significativamente entre os dois grupos (p>0,05). Embora a execução da GS + VGP implique desvascularização da curvatura menor do estômago, observou-se aumento da intensidade da vascularização arterial desta curvatura nos animais do grupo II, conseqüente à dilatação das arteríolas da camada submucosa.

Unitermos: Gastrectomia segmentar; Vagotomia gástrica proximal; Vascularização da curvatura menor.

ABSTRACT

In order to evaluate the possible effects determined by combined body segmental gastrectomy and proximal gastric vagotomy on the arterial vascularization of the lesser curvature of the stomach, twenty-four dogs. weighing 10 to 20 kg, were divided into two groups of 12 animals each: Group 1, animals were submitted to laparotomy and gastric manipulation for 30 minutes; Group II, animals were submitted to segmental gastrectomy with proximal gastric vagotomy. In each group, six animals were sacrificed on the third postoperative day and six on the eighth postoperative day. Neither death nor other postoperative complications occurred. On the sacrifice day barium-gelatin contrast was injected into the arterial vascularization of the stomach, which was then removed from the animal, opened along the greater curvature, fixed in formalin and submitted to radiographs. The intensity of the vascularization of the lesser curvature of the stomach was determined by microdensitometric and molphometric study. By means of microdensitometry. values of the optical densities were determined of the radiograph image of the lesser curvature of the stomach. Considering the microspectrophotometry principies. the values of the optical densities converted in aluminum equivalent were directly proportional to the intensity of vascularization of the gastric lesser curvature. The analysis of the obtained microdensitometry data revealed mean values of optical densities significantly more intense in group 11, when compared to group 1 (p<0.001). On the basis of the morphometric study of the histologic fragment of the lesser curvature, it was observed that: a) the mean arteriole volumes, relative to total submucosa volumes, were significantly greater in group 11 than in group 1 (p<0.001); b) the mean values of the arterioles diameter of the submucosal of group 11 were significantly larger than in the group 1 (p<0.001); c) there was no change in the number of arterioles per mm2 of the submucosal between the two groups (p>0.05). Therefore. it was found an increased intensity of the arterial vascularization of the lesser. The increased vascularization was consequence of arteriole dilatation of the submucosal layer.

Key words: Segmental gastrectomy; PGV; Vascularization of the lesser curvature.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 29/8/97

Aceito para publicação em 16/3/98

1. Jordan Jr PH, Thornby J. Should be parietal cell vagotomy of selective vagotomy-antrectomy for treatment of duodenal ulcer? A progress report. Ann Surg 1987; 205: 572-590.
2. Goligher JC, Hill GL, Kenny TE, et al. Proximal gastric vagotomy without drainage for duodenal ulcer: results after 5-8 years. Br J Surg 1978; 65:145-151.
3. Koo J, Lam SK, Chan P, et al. Proximal gastric vagotomy, truncal vagotomy with drainage, and truncal vagotomy with antrectomy for chronic duodenal ulcero A prospective, randomized controlled trial. Ann Surg 1983; 197:265-271.
4. Hoffmann J, Jensen H-E, Christiansen J, et al. Prospective controlled vagotomy trial for duodenal ulcer. Results after 11-15 years. Ann Surg 1989; 209: 40-45.
5. Ceneviva R. Gastrectomia segmentar associada ŕ vagotomia super-seletiva no tratamento das úlceras duodenais. Rev Assoc Med Bras 1978; 24: 301-302.
6. Oliveira RB, Ceneviva R, Troncon LEA, et al. The effect of a segmental gastrectomy with proximal gastric vagotomy on gastric secretion and gastric emptying. Br J Surg 1984; 71: 431-434.
7. Silva OC. Efeitos da associaçăo da gastrectomia segmentar ŕ vagotomia gástrica proximal nas funçőes gástricas de acomodaçăo ŕ distensăo e de esvaziamento de líquidos e sólidos. Ribeirăo Preto, 1988. 143p. Tese (Doutorado) - Faculdade de Medicina de Ribeirăo Preto da Universidade de Săo Paulo.
8. Andrade JI, Troncon LEA, Ceneviva R, et al. Quantitative assessment of duodenogastric reflux with 99m-Technetium-DISIDA after segmental gastrectomy plus proximal gastric vagotomy. Res Surg 1992;4:46-49.
9. Ceneviva R, Mente ED, Silva Jr OC. Ressecçăo gástrica segmentar associada ŕ vagotomia gástrica proximal no tratamento da úlcera duodenal. Acta Cir Bras 1997; 12 (Suppl 1):39-41.
10. Nilsell K, Liljeqvist L, Lindquist K. Proximal gastric vagotomy and segmental gastrectomy in duodenal ulcer disease: a preliminary report. Acta Chir Scand 1986; 530 (Suppl):23-24.
11. Merz W A. Streekenmessung an gerichteten strukturen im mikroskop und ihre anwendung zur bestimmung von oberflächen volumen - relationen in knochengewebe. Mikroskopie 1968;22: 132.
12. Sala MA, Matheus M, Valeri V. Estimation of the averagediameter of human placental villi by a stereologic method. Micros Acta 1980; 82:339-342.
13. Delesse MA. Procédé mécanique pour déterminer la composition des roches. C R Acad Sci (Paris) 1847; 25:544-545.
14. Anderson VL, Mclean RA. Design of experiments. A realistic approach. New York, Marcel Dekker, 1974.
15. Babkin BP, Armour JC, Webster DR. Restoration of the functional capacity of the stomach when deprived of its main arterial blood supply. Can Med Assoc J 1943;48:1-10.
16. Piasecki C, Wyatt C. Patterns of blood supply to the gastric mucosa. A comparative study revealing an end-artery model. J Anat 1986; 149: 21-39.
17. Schein M, Saadia R. Postoperative gastric ischaemia. Br J Surg 1989; 76:844-848.
18. Barlow TE, Bentley FH, Walder DN. Arteries, veins, and arteriovenous anastomoses in the human stomach. Surg Gynecol Obstet 1951; 93: 657-671.
19. Hallenbeck GA, Gleysteen JJ. Proximal gastric vagotomy without "drainage". An experimental study. Ann Surg 1974;179: 608-617.
20. Bowen JC, Garg DK. Effect of graded mechanical ischemia on oxygen tension and electrical potential in the canine gastric mucosa. A new experimental model. Gastroenterology 1977;73:84-88.
21. Watanabe LM, Andrade n, Sala MA, et al. Efeitos da vagotomia gástrica proximal sobre a vascularizaçăo arterial da curvatura menor do estômago: estudo experimental em căes. Rev Col Bras Cir 1997; 24:293-300.
22. Kumar S, Shahabuddin S, Haboubi N, et al. Angiogenesis factor from human myocardial infarcts. Lancet 1983;2:364-368.
23. Schaper W, De Brabander M, Lewi P. DNA synthesis and mitoses in coronary collateral vessels of the dog. Circ Res 1971; 28:671-679.
24. Schlesinger MJ. New radiopaque mass for vascular injectio. Lab Invest 1957;6:1-11.
25. Baffour R, Danylewick R, Burdon T, et al. An angiographic study of ischemia as a determinant of neovascularization in arteriovenous reversal. Surg Gynecol Obstet 1988; 166: 28-32.
26. Lunde OC, Kvernebo K, Larsen S. Evaluation of endoscopic laser doppler flowmetry for measurement of human gastric blood flow. Methodologic aspects. Scand J Gastroenterol 1988; 23: 1.072-1.078.
27. Seifert J, Lenz J, Brückner W, et al. Are bloodflow changes after selective proximal vagotomy responsible for a necrosis in the gastric wall? Res Exp Med (Berl) 1980; 177: 263-266.
28. Stuart JR, Jordan PH. Unusual complications of subtotal gastric resection. Arch Surg 1957;74: 459-464.
29. Rodgers JB. Infarction of the gastric remnant following subtotal gastrectomy. Arch Surg 1966; 92: 917-921.
30. Barber WH. Annular gastrectomy. Further observations on the cause of its failure. Ann Surg 1933; 98:161-167.
31. Braskén P. Healing of experimental colon anastomosis. Eur J Surg 1991; (suppl.566):4-51.
32. Haddy FJ. Survey of current knowledge on visceral blood flow. Am J Digest Dis 1963; 8:558-563.
33. Lundgren O. Studies on blood flow distribution and countercurrent exchange in the small intestine. Acta Physiol Scand 1967; (suppl. 303):5-42.

Endereço para correspondência:

Dr. Luís Massaro Watanabe

SQN 316 Bloco A Apto. 102

70775-010- Brasília - DF

Datas de Publicação

Publicação nesta coleção
23 Jul 2010
Data do Fascículo
Ago 1998

Histórico

Recebido
29 Ago 1997
Aceito
16 Mar 1998

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Jordan Jr PH, Thornby J. Should be parietal cell vagotomy of selective vagotomy-antrectomy for treatment of duodenal ulcer? A progress report. Ann Surg 1987; 205: 572-590.

[2] 2. Goligher JC, Hill GL, Kenny TE, et al. Proximal gastric vagotomy without drainage for duodenal ulcer: results after 5-8 years. Br J Surg 1978; 65:145-151.

[3] 3. Koo J, Lam SK, Chan P, et al. Proximal gastric vagotomy, truncal vagotomy with drainage, and truncal vagotomy with antrectomy for chronic duodenal ulcero A prospective, randomized controlled trial. Ann Surg 1983; 197:265-271.

[4] 4. Hoffmann J, Jensen H-E, Christiansen J, et al. Prospective controlled vagotomy trial for duodenal ulcer. Results after 11-15 years. Ann Surg 1989; 209: 40-45.

[5] 5. Ceneviva R. Gastrectomia segmentar associada ŕ vagotomia super-seletiva no tratamento das úlceras duodenais. Rev Assoc Med Bras 1978; 24: 301-302.

[6] 6. Oliveira RB, Ceneviva R, Troncon LEA, et al. The effect of a segmental gastrectomy with proximal gastric vagotomy on gastric secretion and gastric emptying. Br J Surg 1984; 71: 431-434.

[7] 7. Silva OC. Efeitos da associaçăo da gastrectomia segmentar ŕ vagotomia gástrica proximal nas funçőes gástricas de acomodaçăo ŕ distensăo e de esvaziamento de líquidos e sólidos. Ribeirăo Preto, 1988. 143p. Tese (Doutorado) - Faculdade de Medicina de Ribeirăo Preto da Universidade de Săo Paulo.

[8] 8. Andrade JI, Troncon LEA, Ceneviva R, et al. Quantitative assessment of duodenogastric reflux with 99m-Technetium-DISIDA after segmental gastrectomy plus proximal gastric vagotomy. Res Surg 1992;4:46-49.

[9] 9. Ceneviva R, Mente ED, Silva Jr OC. Ressecçăo gástrica segmentar associada ŕ vagotomia gástrica proximal no tratamento da úlcera duodenal. Acta Cir Bras 1997; 12 (Suppl 1):39-41.

[10] 10. Nilsell K, Liljeqvist L, Lindquist K. Proximal gastric vagotomy and segmental gastrectomy in duodenal ulcer disease: a preliminary report. Acta Chir Scand 1986; 530 (Suppl):23-24.

[11] 11. Merz W A. Streekenmessung an gerichteten strukturen im mikroskop und ihre anwendung zur bestimmung von oberflächen volumen - relationen in knochengewebe. Mikroskopie 1968;22: 132.

[12] 12. Sala MA, Matheus M, Valeri V. Estimation of the averagediameter of human placental villi by a stereologic method. Micros Acta 1980; 82:339-342.

[13] 13. Delesse MA. Procédé mécanique pour déterminer la composition des roches. C R Acad Sci (Paris) 1847; 25:544-545.

[14] 14. Anderson VL, Mclean RA. Design of experiments. A realistic approach. New York, Marcel Dekker, 1974.

[15] 15. Babkin BP, Armour JC, Webster DR. Restoration of the functional capacity of the stomach when deprived of its main arterial blood supply. Can Med Assoc J 1943;48:1-10.

[16] 16. Piasecki C, Wyatt C. Patterns of blood supply to the gastric mucosa. A comparative study revealing an end-artery model. J Anat 1986; 149: 21-39.

[17] 17. Schein M, Saadia R. Postoperative gastric ischaemia. Br J Surg 1989; 76:844-848.

[18] 18. Barlow TE, Bentley FH, Walder DN. Arteries, veins, and arteriovenous anastomoses in the human stomach. Surg Gynecol Obstet 1951; 93: 657-671.

[19] 19. Hallenbeck GA, Gleysteen JJ. Proximal gastric vagotomy without "drainage". An experimental study. Ann Surg 1974;179: 608-617.

[20] 20. Bowen JC, Garg DK. Effect of graded mechanical ischemia on oxygen tension and electrical potential in the canine gastric mucosa. A new experimental model. Gastroenterology 1977;73:84-88.

[21] 21. Watanabe LM, Andrade n, Sala MA, et al. Efeitos da vagotomia gástrica proximal sobre a vascularizaçăo arterial da curvatura menor do estômago: estudo experimental em căes. Rev Col Bras Cir 1997; 24:293-300.

[22] 22. Kumar S, Shahabuddin S, Haboubi N, et al. Angiogenesis factor from human myocardial infarcts. Lancet 1983;2:364-368.

[23] 23. Schaper W, De Brabander M, Lewi P. DNA synthesis and mitoses in coronary collateral vessels of the dog. Circ Res 1971; 28:671-679.

[24] 24. Schlesinger MJ. New radiopaque mass for vascular injectio. Lab Invest 1957;6:1-11.

[25] 25. Baffour R, Danylewick R, Burdon T, et al. An angiographic study of ischemia as a determinant of neovascularization in arteriovenous reversal. Surg Gynecol Obstet 1988; 166: 28-32.

[26] 26. Lunde OC, Kvernebo K, Larsen S. Evaluation of endoscopic laser doppler flowmetry for measurement of human gastric blood flow. Methodologic aspects. Scand J Gastroenterol 1988; 23: 1.072-1.078.

[27] 27. Seifert J, Lenz J, Brückner W, et al. Are bloodflow changes after selective proximal vagotomy responsible for a necrosis in the gastric wall? Res Exp Med (Berl) 1980; 177: 263-266.

[28] 28. Stuart JR, Jordan PH. Unusual complications of subtotal gastric resection. Arch Surg 1957;74: 459-464.

[29] 29. Rodgers JB. Infarction of the gastric remnant following subtotal gastrectomy. Arch Surg 1966; 92: 917-921.

[30] 30. Barber WH. Annular gastrectomy. Further observations on the cause of its failure. Ann Surg 1933; 98:161-167.

[31] 31. Braskén P. Healing of experimental colon anastomosis. Eur J Surg 1991; (suppl.566):4-51.

[32] 32. Haddy FJ. Survey of current knowledge on visceral blood flow. Am J Digest Dis 1963; 8:558-563.

[33] 33. Lundgren O. Studies on blood flow distribution and countercurrent exchange in the small intestine. Acta Physiol Scand 1967; (suppl. 303):5-42.

Brasil

Brasil

Mudanças na vascularização arterial da curvatura menor do estômago após gastrectomia segmentar associada à vagotomia gástrica proximal em cães

The arterial vascularization changes of the lesser curvature of the stomach after segmental gastrectomy and proximal gastric vagotomy in dogs

Resumos

Datas de Publicação

Histórico