胃癌患者手术前后胃电变化与胃排空之间的相关性研究
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摘要
目的:胃平滑肌始终存在电活动,这种电活动决定和控制着胃平滑肌收缩和舒张。胃平滑肌产生的生物电可传导到体表,胃电图(Electrogastrography,EGG)是通过腹部体表电极记录胃肌电活动的一项非侵入性方法。胃癌患者可能存在胃电节律紊乱。目前胃癌患者胃电变化的特征还不明确,胃癌患者胃电变化与胃排空之间的相关性研究国内外尚未见报道。本研究探讨胃癌患者手术前后胃电变化以及术前胃癌患者胃电变化与胃排空之间的关系,以提高对胃癌患者胃电图的认识,为胃电图的临床应用提供更多依据。
方法:采用瑞典Synectics公司生产的便携式Digitrapper双电极胃电图记录仪对54例胃癌患者,其中胃癌术前患者27例(男14例,女13例,平均年龄47.19岁),胃癌术后患者27例(男14例,女13例,平均年龄48.52岁);20例健康志愿者(男10例,女10例,平均年龄45.21岁)进行胃电图记录。餐前记录30分钟,餐后记录60分钟。胃电参数包括正常慢波节律百分比(N%)、主频(DF)、主功率(DP)、胃动过缓(B%)、胃动过速(T%)、主频不稳定系数(DFIC)、餐后/餐前功率比(PR)。采用Rom’s法(不透X线标志物法)进行胃排空检测。计算4小时胃排空率,以4小时胃排空率≤80%为胃排空延迟。胃排空率(%)=[(20-胃内钡条残留数)/20]×100%。采用SPSS 11.5统计软件进行数据统计分析,所有数据用均数±标准差( x|-±S)表示,P<0.05被认为有统计学意义。
结果: 1胃癌术前组和正常对照组主功率餐前(39.47±12.86 vs 29.16±4.71, P<0.001),餐后(42.78±13.53 vs 33.24±2.47, P<0.05),胃动过速百分比餐前(23.17±13.84 vs 13.12±10.67, P<0.05),餐后(23.71±13.67 vs 10.91±8.01, P< 0.001),正常慢波节律百分比餐前(66.37±14.99 vs 76.38±13.66,P<0.05),餐后(67.43±13.28 vs 77.39±12.62,P<0.05),胃癌术前组主功率和胃动过速百分比均高于正常对照组,正常慢波节律百分比低于正常对照组。
胃癌术前组餐前、后主频(2.83±0.35 vs 2.90±0.38 cpm,P< 0.05),主功率(39.47±12.86 vs 42.78±13.53 P<0.05),餐后均增加。进餐对胃癌术前组其他胃电参数无明显影响。胃癌术前组各胃电参数与性别、年龄、体重指数无明显相关性;正常对照组餐后/餐前功率比与体重指数呈正相关(r=0.422, P=0.045),正常对照组各胃电参数与性别和年龄无明显相关性。
餐前、后胃癌术前患者BorrmannⅠ、Ⅱ、Ⅲ、Ⅳ型间的各胃电参数差异均无统计学意义(P>0.05)。贲门癌、胃体癌、胃窦癌三组间各胃电参数差异均无统计学意义(P>0.05)。
正常人胃电记录波形示餐后胃电图振幅明显升高,三维图示胃电频率规则,主频率每分钟3cpm;胃癌术前患者胃电记录波形示餐后胃电图振幅升高,胃电图波形不规则,三维图示胃电频率不规则。
2胃癌术后组和正常对照组主频餐前(2.53±0.36 vs2.92±0.26 cpm, P<0.05),餐后(2.68±0.34 vs 3.04±0.20 cpm, P<0.05),正常慢波节律百分比餐前(62.01±13.82 vs 76.38±13.66,P<0.05),餐后(60.04±11.53 vs 77.39±12.62, P<0.001),胃动过缓百分比餐前(15.19±11.01 vs 7.17±6.48, P<0.05),餐后(15.82±7.30 vs 7.99±5.81, P<0.001),胃动过速百分比餐前(19.48±9.99 vs 13.12±10.67, P<0.05),餐后(21.83±8.61 vs 10.91±8.01, P<0.001),胃癌术后组主频和正常慢波节律百分比均低于正常对照组,胃动过缓百分比和胃动过速百分比均高于正常对照组。餐后胃癌术后组与正常对照组主频不稳定系数(0.45±0.10 vs 0.32±0.11, P<0.001),主频不稳定系数高于正常对照组。
近端胃大部切除、远端胃大部切除和全胃切除患者主频餐前(3.01±0.38 vs 3.06±0.29 vs 2.54±0.12 cpm, F=6.225,P=0.007),餐后(2.88±0.36 vs 2.84±0.37 vs 2.30±0.12 cpm, F=5.315,P=0.013),正常慢波节律百分比餐前(63.95±9.96 vs 66.58±12.69 vs 44.00±2.80, F=8.094, P=0.002),餐后(61.32±4.74 vs 63.97±13.68 vs 46.44±11.50, F=4.113,P=0.030),有统计学意义。近端胃大部切除和远端胃大部切除患者之间主频和正常慢波节律百分比无统计学意义(P>0.05);近端胃大部切除、远端胃大部切除患者主频和正常慢波节律百分比高于全胃切除患者(P<0.05);餐后/餐前功率比(1.27±0.24 vs 1.04±0.13 vs 1.12±0.22, F=3.580, P=0.045),有统计学意义。近端胃大部切除患者餐后/餐前功率比高于全胃切除患者(P<0.05);远端胃大部切除和近端胃大部切除、全胃切除患者之间均无统计学意义(P>0.05)。
全胃切除患者胃电记录波形不规则,三维图示胃电频率不规则,3cpm胃电频率消失;胃次全切除患者胃电记录波形不规则,三维图示胃电频率不规则,但仍可检测到3cpm胃电频率。
3胃癌术后组与胃癌术前组主频餐前(2.53±0.36 vs 2.83±0.35 cpm, P<0.05),餐后(2.68±0.34 vs 2.90±0.38 cpm, P<0.001),主功率餐前(31.54±6.54 vs 39.47±12.86,P<0.05),餐后(34.15±4.28 vs 42.78±13.53,P<0.05),胃动过缓百分比餐前(15.19±11.01 vs 7.90±6.13,P<0.05),餐后(15.82±7.30 vs 7.32±3.19,P<0.001),正常慢波节律百分比餐前(62.01±13.82 vs 66.37±14.99,P<0.05),餐后(60.04±11.53 vs 67.43±13.28,P<0.05),胃癌术后组主频、主功率和正常慢波节律百分比低于胃癌术前组,胃动过缓百分比高于胃癌术前组。
4 20例正常对照者中,胃排空正常率75%;27例胃癌术前患者中,胃排空正常率33.3%。两组之间差异有统计学意义(P=0.007)。
18例胃排空延迟的胃癌术前患者中,胃电图异常率83.33%;胃电图异常者中胃动过速73.33%;胃动过缓26.67%。胃排空正常的胃癌术前患者中胃电图异常33.3%,均为胃动过速。5例胃排空延迟的正常对照者中,胃电图异常60%,均为胃动过速;15例胃排空正常者中胃电图异常20%,均为胃动过速。
胃癌术前组正常慢波节律百分比与4小时胃排空率之间呈正相关(r=0.406,P=0.04),(r=0.401,P=0.042),胃动过速百分比与4小时胃排空率之间呈负相关(r=-0.468,P= 0.016),(r=-0.604,P=0.001)。正常对照组餐前各胃电参数与4小时胃排空率之间均无相关性(P>0.05),餐后正常慢波节律百分比与4小时胃排空率之间呈正相关(r=0.473,P= 0.030 ),胃动过缓与4小时胃排空率之间呈负相关(r=-0.483,P=0.027)。
结论: 1与正常对照者相比,胃癌术前患者胃电节律紊乱主要表现为正常慢波节律百分比下降,主功率和胃动过速百分比升高。性别、年龄、体重指数、Borrmann分型和肿瘤位置对胃癌术前患者的胃电变化无明显影响。
2与正常对照者相比,胃癌术后患者胃电节律紊乱主要表现为主频和正常慢波节律百分比下降,胃动过速和胃动过缓百分比升高。近端胃大部切除和远端胃大部切除患者之间胃电参数无明显变化。
3与胃癌术前患者相比,胃癌术后者胃电紊乱率升高,主要表现为主频、主功率和正常慢波节律百分比下降,胃动过缓百分比升高。
4胃癌术前患者存在胃排空延迟,并且胃排空延迟者多伴胃动过速。胃癌术前患者正常慢波节律百分比与4小时胃排空率呈正相关,胃动过速百分比与4小时胃排空率呈负相关。
Objective: Gastric electric activity of stomach smooth muscles controls its contraction and dilatation, one of rhythmic myoelectrical signal changes of gastric electric activity could be recorded by electrogastrogram (EGG), one of the noninvasive methods, through the abdominal electrodes. Character of gastric electric activity changes in gastric cancer patients is still indefinite, and relationship between gastric electric activity changes and gastric emptying has not been reported to our knowledge. To know the character of electrogastrogram in gastric cancer patients, provide more evidence to electrogas trogram clinical application, we compared the EGG changes in preoperative and postoperative gastric cancer patients, and relationship between preoperative gastric electric activity and gastric emptying.
Methods: EGG was recorded by mobile Digitrapper dipl-electrode electrogastrogram recorder (Synectics Company, Sweden), 54 gastric cancer patients including 27 preoperative gastric cancer (Pre-GC) patients (14 males and 13 females, the average age was 47.19) and 27 postoperative gastric cancer (Post-GC) patients (14 males and 13 females, the average age was 48.52) and 20 health controls (10 males and 10 females, the average age was 45.21) were involved in this study. The fasting measurement was recorded for 30 minutes and the postprandial recording for 60 minutes. The EGG parameters contained dominant frequency (DF), dominant frequency in normal range (N%), dominnant power (DP), bradygastria (B%), tachygastria (T%), dominant frequency instability coefficient (DFIC), and power ratio (PR), respectively. Four hour’s gastric emptying rate was calculated by Rom’s method. Gastric emptying rate≤80% was considered as delayed gastric emptying. All statistical analysis was performed by SPSS 11.5 software, P<0.05 was considered as significant.
Results: 1 Compared with controls fasting DP was 39.47±12.86 of Pre-GC patients vs 29.16±4.71 of controls (P<0.001); so do postprandial DP 42.78±13.53 of Pre-GC patients vs 33.24±2.47 of controls (P<0.05). Compared with controls fasting T% was 23.17±13.84 of Pre-GC patients vs 13.12±10.67 of control- s (P<0.05); so do postprandial T% 23.71±13.67 of Pre-GC patients vs 10.91±8.01 of controls (P<0.001). Compared with controls fasting N% was 66.37±14.99 of Pre-GC patients vs 76.38±13.66 of controls (P<0.05); so do postprandial N% 67.43±13.28 of Pre-GC patients vs 77.39±12.62 of controls (P<0.05). DP and T% in Pre-GC were all significantly higher than that of controls; N% was lower than controls.
Postprandial DF was increased compared with fasting, so do DP. DF and DP of Pre-GC patients upon meal induction were 2.83±0.35 vs 2.90±0.38 cpm (P<0.05); 39.47±12.86 vs 42.78±13.53 (P<0.05) respectively. But other gastric electrical activity parameters were unchanged (data not shown). Sex, age and BMI of Pre-GC patients had no influences on gastric electrical activity parameters; PR of controls had positive correlation with BMI (r=0.422, P=0.045). Age and sex of controls had no influences on gastric electrical activity parameters.
All fasting and postprandial parameters of Pre-GC patients among four groups (BorrmannⅠ,Ⅱ,Ⅲ,Ⅳ) had no significant difference (P>0.05). Parameters among three groups (carcino- ma of gastric cardia, corpus gastricum and sinus ventriculi) had no significant difference (P>0.05).
Compared with fasting postprandial amplitude vibration of controls increased by EGG recording, gastric electrical frequent- cy was regular in three-dimension graphics, DF was 3cpm per minute; Compared with fasting postprandial amplitude vibration of Pre-GC patients also increased by EGG recording, but electrogastrogram wave was irregular, gastric electrical frequen- tcy was irregular in three-dimension graphics.
2 Fasting DF was 2.53±0.36 cpm of Post-GC patients, 2.92±0.26 cpm of controls (P<0.05); Postprandial DF was 2.68±0.34 cpm of Post-GC patients, 3.04±0.20 cpm of controls (P<0.05). Fasting N% was 62.01±13.82 of Post-GC patients, 76.38±13.66 of controls (P<0.05); Postprandial N% was 60.04±11.53 of Post-GC patients, 77.39±12.62 of controls (P<0.001). Fasting B% was 15.19±11.01 of Post-GC patients, 7.17±6.48 of controls (P<0.05); Postprandial B% was 15.82±7.30 of Post-GC patients; 7.99±5.81 of controls (P<0.001). Fasting T% was 19.48±9.99 of Post-GC patients, 13.12±10.67 of controls (P<0.05); Postprandi- al T% was 21.83±8.61 of Post-GC patients; 10.91±8.01 of controls (P<0.001). DF and N% of Post-GC patients were all lower than that of controls, B% and T% were higher than that of controls, postprandial DFIC was 0.45±0.10 of Post-GC patients, 0.32±0.11 of controls (P<0.001). DFIC of Post-GC patients were higher than controls.
EGG wave of total gastrectomy patients was irregular, gastric electrical frequency was irregular in three-dimension graphics and 3cpm wave was disappeared; In subtotal gastric- tomy patients, gastric electrical activity frequency was irregular in three-dimension graphics, but 3cpm wave can be detected.
Fasting DF was 3.01±0.38 cpm in proximal gastrectomy, 3.06±0.29 cpm in distal gastrectomy, 2.54±0.12 cpm in total gastrectomy (F=6.225, P=0.007); Postprandial DF was 2.88±0.36 cpm in proximal gastrectomy, 2.84±0.37 cpm in distal gastrectomy, 2.30±0.1 cpm in total gastrectomy (F=5.315, P=0.013). Fasting N% was 63.95±9.96 in proximal gastrectomy, 66.58±12.69in distal gastrectomy, 44.00±2.80 in total gastric- tomy (F=8.094, P=0.002); Postprandial N% was 61.32±4.74 in proximal gastrectomy, 63.97±13.68 in distal gastrectomy, 46.44±11.50 in total gastrectomy (F=4.113, P=0.030). DF and N% had no significant difference between proximal gastrectomy and distal gastrectomy (P>0.05); DF and N% of proximal gastric- tomy and distal gastrectomy were higher than total gastrectomy (P<0.05); PR was 1.27±0.24 in proximal gastrectomy, 1.04±0.13 in distal gastrectomy, 1.12±0.22 in total gastrectomy (F=3.580, P=0.045). PR of proximal gastrectomy was higher than that of total gastrectomy patients (P<0.05); there was no signi- ficant difference between proximal gastrictomy and distal gastri- ctomy, also distal gastrectomy and total gastrectomy patients (P>0.05).
3 Fasting DF was 2.53±0.36 cpm in Post-GC patients, 2.83±0.35 cpm in Pre-GC patients (P<0.05); Postprandial DF was 2.68±0.34 cpm in Post-GC patients, 2.90±0.38 cpm in Pre-GC patients (P<0.001). Fasting DP was 31.54±6.54 in Post-GC patients, 39.47±12.86 in Pre-GC patients (P<0.05); Postprandial DP was 34.15±4.28 in Post-GC patients, 42.78±13.53 in Pre-GC (P<0.05). Fasting B% was 15.19±11.01 in Post-GC patients, 7.90±6.13 in Pre-GC patients (P<0.05); Postprandial B% was 15.82±7.30 in Post-GC patients, 7.32±3.19 in Pre-GC patients (P<0.001). Fasting N% was 62.01±13.82 in Post-GC patients, 66.37±14.99 in Pre-GC patients (P<0.05); Postprandial N% was 60.04±11.53 in Post-GC patients, 67.43±13.28 in Pre-GC (P<0.05). DF and DP of Post-GC patients were lower than Pre-GC patients, B% was higher than Pre-GC patients, and postprandial N% was lower than Pre-GC patients.
4 In 20 controls, 75 percent with normal gastric emptying; in 27 Pre-GC patients, 33.3 percent with normal gastric emptying. There was significant difference between two groups (P=0.007).
In 18 Pre-GC patients showed delayed gastric emptying, 83.33 percent with abnormal electrogastrogram; in patients with abnormal electrogastrogram, 73.33 percent with tachygastria, and 26.67 percent with bradygastria. In Pre-GC patients showed normal gastric emptying, 33.3 percent with abnormal electro- gastrogram, all with tachygastria. In 5 controls showed delayed gastric emptying, 60 percent with abnormal electrogastrogram, all with tachygastria. In 15 controls showed normal gastric emptying, 20 percent with abnormal electrogastrogram, all with tachygastria.
In Pre-GC patients, fasting and postprandial N% were positively correlated with four hour’s gastric emptying rate (r=0.406, P=0.04), (r=0.401, P=0.042), T% was negatively correlated with four hour’s gastric emptying rate (r=-0.468, P=0.016), (r=-0.604, P=0.001). Whereas, in the normal controls, there were no relationship between all fasting parameters and four hour’s gastric emptying rate, postprandial N% was positively correlated with four hour’s gastric emptying rate (r=0.473, P=0.030), B% was negatively correlated with four hour’s gastric emptying rate (r=-0.483, P=0.027).
Conclusions: 1 Compare with controls, abnormal gastric myoelectrical activity of Pre-GC patients are include the decrease of N%, increase of DP and T%. Sex, age, BMI, Borrmann classification and tumor location have no obviously influences respectively on parameters of Pre-GC patients.
2 Compare with controls, abnormal gastric myoelectrical activity of Post-GC patients are include the decrease of DF and N%, increase of T% and B%. No statistical defference exists between gastric electrical activity parameters of proximal gastrectomy and that of distal gastrectomy.
3 Compare with Pre-GC patients, abnormal gastric electrical activity rate of Post-GC is increased, mainly include the decrease of DF, N% and DP, increase of B%.
4 Delayed gastric emptying may exist in gastric cancer patients, and delayed gastric emptying is more accompany with tachygastria. In Pre-GC patients, N% is positively correlated with four hour’s gastric emptying rate; T% is negatively correlated with four hour’s gastric emptying rate.
方法:采用瑞典Synectics公司生产的便携式Digitrapper双电极胃电图记录仪对54例胃癌患者,其中胃癌术前患者27例(男14例,女13例,平均年龄47.19岁),胃癌术后患者27例(男14例,女13例,平均年龄48.52岁);20例健康志愿者(男10例,女10例,平均年龄45.21岁)进行胃电图记录。餐前记录30分钟,餐后记录60分钟。胃电参数包括正常慢波节律百分比(N%)、主频(DF)、主功率(DP)、胃动过缓(B%)、胃动过速(T%)、主频不稳定系数(DFIC)、餐后/餐前功率比(PR)。采用Rom’s法(不透X线标志物法)进行胃排空检测。计算4小时胃排空率,以4小时胃排空率≤80%为胃排空延迟。胃排空率(%)=[(20-胃内钡条残留数)/20]×100%。采用SPSS 11.5统计软件进行数据统计分析,所有数据用均数±标准差( x|-±S)表示,P<0.05被认为有统计学意义。
结果: 1胃癌术前组和正常对照组主功率餐前(39.47±12.86 vs 29.16±4.71, P<0.001),餐后(42.78±13.53 vs 33.24±2.47, P<0.05),胃动过速百分比餐前(23.17±13.84 vs 13.12±10.67, P<0.05),餐后(23.71±13.67 vs 10.91±8.01, P< 0.001),正常慢波节律百分比餐前(66.37±14.99 vs 76.38±13.66,P<0.05),餐后(67.43±13.28 vs 77.39±12.62,P<0.05),胃癌术前组主功率和胃动过速百分比均高于正常对照组,正常慢波节律百分比低于正常对照组。
胃癌术前组餐前、后主频(2.83±0.35 vs 2.90±0.38 cpm,P< 0.05),主功率(39.47±12.86 vs 42.78±13.53 P<0.05),餐后均增加。进餐对胃癌术前组其他胃电参数无明显影响。胃癌术前组各胃电参数与性别、年龄、体重指数无明显相关性;正常对照组餐后/餐前功率比与体重指数呈正相关(r=0.422, P=0.045),正常对照组各胃电参数与性别和年龄无明显相关性。
餐前、后胃癌术前患者BorrmannⅠ、Ⅱ、Ⅲ、Ⅳ型间的各胃电参数差异均无统计学意义(P>0.05)。贲门癌、胃体癌、胃窦癌三组间各胃电参数差异均无统计学意义(P>0.05)。
正常人胃电记录波形示餐后胃电图振幅明显升高,三维图示胃电频率规则,主频率每分钟3cpm;胃癌术前患者胃电记录波形示餐后胃电图振幅升高,胃电图波形不规则,三维图示胃电频率不规则。
2胃癌术后组和正常对照组主频餐前(2.53±0.36 vs2.92±0.26 cpm, P<0.05),餐后(2.68±0.34 vs 3.04±0.20 cpm, P<0.05),正常慢波节律百分比餐前(62.01±13.82 vs 76.38±13.66,P<0.05),餐后(60.04±11.53 vs 77.39±12.62, P<0.001),胃动过缓百分比餐前(15.19±11.01 vs 7.17±6.48, P<0.05),餐后(15.82±7.30 vs 7.99±5.81, P<0.001),胃动过速百分比餐前(19.48±9.99 vs 13.12±10.67, P<0.05),餐后(21.83±8.61 vs 10.91±8.01, P<0.001),胃癌术后组主频和正常慢波节律百分比均低于正常对照组,胃动过缓百分比和胃动过速百分比均高于正常对照组。餐后胃癌术后组与正常对照组主频不稳定系数(0.45±0.10 vs 0.32±0.11, P<0.001),主频不稳定系数高于正常对照组。
近端胃大部切除、远端胃大部切除和全胃切除患者主频餐前(3.01±0.38 vs 3.06±0.29 vs 2.54±0.12 cpm, F=6.225,P=0.007),餐后(2.88±0.36 vs 2.84±0.37 vs 2.30±0.12 cpm, F=5.315,P=0.013),正常慢波节律百分比餐前(63.95±9.96 vs 66.58±12.69 vs 44.00±2.80, F=8.094, P=0.002),餐后(61.32±4.74 vs 63.97±13.68 vs 46.44±11.50, F=4.113,P=0.030),有统计学意义。近端胃大部切除和远端胃大部切除患者之间主频和正常慢波节律百分比无统计学意义(P>0.05);近端胃大部切除、远端胃大部切除患者主频和正常慢波节律百分比高于全胃切除患者(P<0.05);餐后/餐前功率比(1.27±0.24 vs 1.04±0.13 vs 1.12±0.22, F=3.580, P=0.045),有统计学意义。近端胃大部切除患者餐后/餐前功率比高于全胃切除患者(P<0.05);远端胃大部切除和近端胃大部切除、全胃切除患者之间均无统计学意义(P>0.05)。
全胃切除患者胃电记录波形不规则,三维图示胃电频率不规则,3cpm胃电频率消失;胃次全切除患者胃电记录波形不规则,三维图示胃电频率不规则,但仍可检测到3cpm胃电频率。
3胃癌术后组与胃癌术前组主频餐前(2.53±0.36 vs 2.83±0.35 cpm, P<0.05),餐后(2.68±0.34 vs 2.90±0.38 cpm, P<0.001),主功率餐前(31.54±6.54 vs 39.47±12.86,P<0.05),餐后(34.15±4.28 vs 42.78±13.53,P<0.05),胃动过缓百分比餐前(15.19±11.01 vs 7.90±6.13,P<0.05),餐后(15.82±7.30 vs 7.32±3.19,P<0.001),正常慢波节律百分比餐前(62.01±13.82 vs 66.37±14.99,P<0.05),餐后(60.04±11.53 vs 67.43±13.28,P<0.05),胃癌术后组主频、主功率和正常慢波节律百分比低于胃癌术前组,胃动过缓百分比高于胃癌术前组。
4 20例正常对照者中,胃排空正常率75%;27例胃癌术前患者中,胃排空正常率33.3%。两组之间差异有统计学意义(P=0.007)。
18例胃排空延迟的胃癌术前患者中,胃电图异常率83.33%;胃电图异常者中胃动过速73.33%;胃动过缓26.67%。胃排空正常的胃癌术前患者中胃电图异常33.3%,均为胃动过速。5例胃排空延迟的正常对照者中,胃电图异常60%,均为胃动过速;15例胃排空正常者中胃电图异常20%,均为胃动过速。
胃癌术前组正常慢波节律百分比与4小时胃排空率之间呈正相关(r=0.406,P=0.04),(r=0.401,P=0.042),胃动过速百分比与4小时胃排空率之间呈负相关(r=-0.468,P= 0.016),(r=-0.604,P=0.001)。正常对照组餐前各胃电参数与4小时胃排空率之间均无相关性(P>0.05),餐后正常慢波节律百分比与4小时胃排空率之间呈正相关(r=0.473,P= 0.030 ),胃动过缓与4小时胃排空率之间呈负相关(r=-0.483,P=0.027)。
结论: 1与正常对照者相比,胃癌术前患者胃电节律紊乱主要表现为正常慢波节律百分比下降,主功率和胃动过速百分比升高。性别、年龄、体重指数、Borrmann分型和肿瘤位置对胃癌术前患者的胃电变化无明显影响。
2与正常对照者相比,胃癌术后患者胃电节律紊乱主要表现为主频和正常慢波节律百分比下降,胃动过速和胃动过缓百分比升高。近端胃大部切除和远端胃大部切除患者之间胃电参数无明显变化。
3与胃癌术前患者相比,胃癌术后者胃电紊乱率升高,主要表现为主频、主功率和正常慢波节律百分比下降,胃动过缓百分比升高。
4胃癌术前患者存在胃排空延迟,并且胃排空延迟者多伴胃动过速。胃癌术前患者正常慢波节律百分比与4小时胃排空率呈正相关,胃动过速百分比与4小时胃排空率呈负相关。
Objective: Gastric electric activity of stomach smooth muscles controls its contraction and dilatation, one of rhythmic myoelectrical signal changes of gastric electric activity could be recorded by electrogastrogram (EGG), one of the noninvasive methods, through the abdominal electrodes. Character of gastric electric activity changes in gastric cancer patients is still indefinite, and relationship between gastric electric activity changes and gastric emptying has not been reported to our knowledge. To know the character of electrogastrogram in gastric cancer patients, provide more evidence to electrogas trogram clinical application, we compared the EGG changes in preoperative and postoperative gastric cancer patients, and relationship between preoperative gastric electric activity and gastric emptying.
Methods: EGG was recorded by mobile Digitrapper dipl-electrode electrogastrogram recorder (Synectics Company, Sweden), 54 gastric cancer patients including 27 preoperative gastric cancer (Pre-GC) patients (14 males and 13 females, the average age was 47.19) and 27 postoperative gastric cancer (Post-GC) patients (14 males and 13 females, the average age was 48.52) and 20 health controls (10 males and 10 females, the average age was 45.21) were involved in this study. The fasting measurement was recorded for 30 minutes and the postprandial recording for 60 minutes. The EGG parameters contained dominant frequency (DF), dominant frequency in normal range (N%), dominnant power (DP), bradygastria (B%), tachygastria (T%), dominant frequency instability coefficient (DFIC), and power ratio (PR), respectively. Four hour’s gastric emptying rate was calculated by Rom’s method. Gastric emptying rate≤80% was considered as delayed gastric emptying. All statistical analysis was performed by SPSS 11.5 software, P<0.05 was considered as significant.
Results: 1 Compared with controls fasting DP was 39.47±12.86 of Pre-GC patients vs 29.16±4.71 of controls (P<0.001); so do postprandial DP 42.78±13.53 of Pre-GC patients vs 33.24±2.47 of controls (P<0.05). Compared with controls fasting T% was 23.17±13.84 of Pre-GC patients vs 13.12±10.67 of control- s (P<0.05); so do postprandial T% 23.71±13.67 of Pre-GC patients vs 10.91±8.01 of controls (P<0.001). Compared with controls fasting N% was 66.37±14.99 of Pre-GC patients vs 76.38±13.66 of controls (P<0.05); so do postprandial N% 67.43±13.28 of Pre-GC patients vs 77.39±12.62 of controls (P<0.05). DP and T% in Pre-GC were all significantly higher than that of controls; N% was lower than controls.
Postprandial DF was increased compared with fasting, so do DP. DF and DP of Pre-GC patients upon meal induction were 2.83±0.35 vs 2.90±0.38 cpm (P<0.05); 39.47±12.86 vs 42.78±13.53 (P<0.05) respectively. But other gastric electrical activity parameters were unchanged (data not shown). Sex, age and BMI of Pre-GC patients had no influences on gastric electrical activity parameters; PR of controls had positive correlation with BMI (r=0.422, P=0.045). Age and sex of controls had no influences on gastric electrical activity parameters.
All fasting and postprandial parameters of Pre-GC patients among four groups (BorrmannⅠ,Ⅱ,Ⅲ,Ⅳ) had no significant difference (P>0.05). Parameters among three groups (carcino- ma of gastric cardia, corpus gastricum and sinus ventriculi) had no significant difference (P>0.05).
Compared with fasting postprandial amplitude vibration of controls increased by EGG recording, gastric electrical frequent- cy was regular in three-dimension graphics, DF was 3cpm per minute; Compared with fasting postprandial amplitude vibration of Pre-GC patients also increased by EGG recording, but electrogastrogram wave was irregular, gastric electrical frequen- tcy was irregular in three-dimension graphics.
2 Fasting DF was 2.53±0.36 cpm of Post-GC patients, 2.92±0.26 cpm of controls (P<0.05); Postprandial DF was 2.68±0.34 cpm of Post-GC patients, 3.04±0.20 cpm of controls (P<0.05). Fasting N% was 62.01±13.82 of Post-GC patients, 76.38±13.66 of controls (P<0.05); Postprandial N% was 60.04±11.53 of Post-GC patients, 77.39±12.62 of controls (P<0.001). Fasting B% was 15.19±11.01 of Post-GC patients, 7.17±6.48 of controls (P<0.05); Postprandial B% was 15.82±7.30 of Post-GC patients; 7.99±5.81 of controls (P<0.001). Fasting T% was 19.48±9.99 of Post-GC patients, 13.12±10.67 of controls (P<0.05); Postprandi- al T% was 21.83±8.61 of Post-GC patients; 10.91±8.01 of controls (P<0.001). DF and N% of Post-GC patients were all lower than that of controls, B% and T% were higher than that of controls, postprandial DFIC was 0.45±0.10 of Post-GC patients, 0.32±0.11 of controls (P<0.001). DFIC of Post-GC patients were higher than controls.
EGG wave of total gastrectomy patients was irregular, gastric electrical frequency was irregular in three-dimension graphics and 3cpm wave was disappeared; In subtotal gastric- tomy patients, gastric electrical activity frequency was irregular in three-dimension graphics, but 3cpm wave can be detected.
Fasting DF was 3.01±0.38 cpm in proximal gastrectomy, 3.06±0.29 cpm in distal gastrectomy, 2.54±0.12 cpm in total gastrectomy (F=6.225, P=0.007); Postprandial DF was 2.88±0.36 cpm in proximal gastrectomy, 2.84±0.37 cpm in distal gastrectomy, 2.30±0.1 cpm in total gastrectomy (F=5.315, P=0.013). Fasting N% was 63.95±9.96 in proximal gastrectomy, 66.58±12.69in distal gastrectomy, 44.00±2.80 in total gastric- tomy (F=8.094, P=0.002); Postprandial N% was 61.32±4.74 in proximal gastrectomy, 63.97±13.68 in distal gastrectomy, 46.44±11.50 in total gastrectomy (F=4.113, P=0.030). DF and N% had no significant difference between proximal gastrectomy and distal gastrectomy (P>0.05); DF and N% of proximal gastric- tomy and distal gastrectomy were higher than total gastrectomy (P<0.05); PR was 1.27±0.24 in proximal gastrectomy, 1.04±0.13 in distal gastrectomy, 1.12±0.22 in total gastrectomy (F=3.580, P=0.045). PR of proximal gastrectomy was higher than that of total gastrectomy patients (P<0.05); there was no signi- ficant difference between proximal gastrictomy and distal gastri- ctomy, also distal gastrectomy and total gastrectomy patients (P>0.05).
3 Fasting DF was 2.53±0.36 cpm in Post-GC patients, 2.83±0.35 cpm in Pre-GC patients (P<0.05); Postprandial DF was 2.68±0.34 cpm in Post-GC patients, 2.90±0.38 cpm in Pre-GC patients (P<0.001). Fasting DP was 31.54±6.54 in Post-GC patients, 39.47±12.86 in Pre-GC patients (P<0.05); Postprandial DP was 34.15±4.28 in Post-GC patients, 42.78±13.53 in Pre-GC (P<0.05). Fasting B% was 15.19±11.01 in Post-GC patients, 7.90±6.13 in Pre-GC patients (P<0.05); Postprandial B% was 15.82±7.30 in Post-GC patients, 7.32±3.19 in Pre-GC patients (P<0.001). Fasting N% was 62.01±13.82 in Post-GC patients, 66.37±14.99 in Pre-GC patients (P<0.05); Postprandial N% was 60.04±11.53 in Post-GC patients, 67.43±13.28 in Pre-GC (P<0.05). DF and DP of Post-GC patients were lower than Pre-GC patients, B% was higher than Pre-GC patients, and postprandial N% was lower than Pre-GC patients.
4 In 20 controls, 75 percent with normal gastric emptying; in 27 Pre-GC patients, 33.3 percent with normal gastric emptying. There was significant difference between two groups (P=0.007).
In 18 Pre-GC patients showed delayed gastric emptying, 83.33 percent with abnormal electrogastrogram; in patients with abnormal electrogastrogram, 73.33 percent with tachygastria, and 26.67 percent with bradygastria. In Pre-GC patients showed normal gastric emptying, 33.3 percent with abnormal electro- gastrogram, all with tachygastria. In 5 controls showed delayed gastric emptying, 60 percent with abnormal electrogastrogram, all with tachygastria. In 15 controls showed normal gastric emptying, 20 percent with abnormal electrogastrogram, all with tachygastria.
In Pre-GC patients, fasting and postprandial N% were positively correlated with four hour’s gastric emptying rate (r=0.406, P=0.04), (r=0.401, P=0.042), T% was negatively correlated with four hour’s gastric emptying rate (r=-0.468, P=0.016), (r=-0.604, P=0.001). Whereas, in the normal controls, there were no relationship between all fasting parameters and four hour’s gastric emptying rate, postprandial N% was positively correlated with four hour’s gastric emptying rate (r=0.473, P=0.030), B% was negatively correlated with four hour’s gastric emptying rate (r=-0.483, P=0.027).
Conclusions: 1 Compare with controls, abnormal gastric myoelectrical activity of Pre-GC patients are include the decrease of N%, increase of DP and T%. Sex, age, BMI, Borrmann classification and tumor location have no obviously influences respectively on parameters of Pre-GC patients.
2 Compare with controls, abnormal gastric myoelectrical activity of Post-GC patients are include the decrease of DF and N%, increase of T% and B%. No statistical defference exists between gastric electrical activity parameters of proximal gastrectomy and that of distal gastrectomy.
3 Compare with Pre-GC patients, abnormal gastric electrical activity rate of Post-GC is increased, mainly include the decrease of DF, N% and DP, increase of B%.
4 Delayed gastric emptying may exist in gastric cancer patients, and delayed gastric emptying is more accompany with tachygastria. In Pre-GC patients, N% is positively correlated with four hour’s gastric emptying rate; T% is negatively correlated with four hour’s gastric emptying rate.
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20 Pezzolla F, Riezzo G, Maselli MA, et al. Electrical activity recorded from abdominal surface after gastrectomy or collec- tomy in humans. Gastroenterology. 1989, 97(2): 313-320
21 Homma S, Shimakage N, Yagi M, et al. Electrogastrography prior to and following total gastrectomy, subtotal gastric- tomy, and gastric tube formation. Dig Dis Sci. 1995, 40 (4): 893-900
22 Imai K,Sakita M. Pre-and postoperative electrogastrography in patients with cancer gastric. Hepatogastroenterology. 2005, 52(62):639-644
23 Hayashi T, Kinami S, Fushida S, et al. Evaluation of residual stomach motility after proximal gastrectomy for gastric cancer by electrogastrography. Dig Dis Sci. 2006, 51 (2): 268 -273
24 王德山,张立德,柴纪严等.胃癌胃电图特异性波形临床研究.锦州医学院学报.1997, 18(4):7-9
25 陈道志,秦良才,陈莉萍等.胃癌患者四道胃电图特征的观察.中华消化杂志.1997, 17:67-68
26 黄少辉,许冠荪,寇素霞.32 例胃癌患者胃电图特征及分析.安徽中医学院学.1992, 11(2):59-60
27 王德山,冯甲棣,张立德等.胃电图波形与胃、十二指肠疾患关系的研究.中国医科大学学报.1998, 27(2):126-128
28 Lin X, Mellow MH, Southmay DL, et al. Impaired gastric myoelectrical activity in patients with chronic renal failure. Dig Dis Sci. 1997, 42(5):898-906
29 陈艳敏,赵石,范红等.尿毒症患者的体表胃电图研究.华人消化志.1998, 6(11):979-981
30 Chen JD, Pan J, Mccallum RW. Clinical significance of gastric myoelectrical dysrhythmias. Dig Dis Sci. 1995, 13(5): 275-290
31 Chen JD, Ke MY, Lin XM,et al. Cisapride provides symp- tommatic relief in functional dyspepsia associated with gastric myoelectrical abnormality. Aliment Pharmacol Ther. 2000, 14(8):1041-1047
32 Brown BH, Smallwood RH, et al. Intestinal smooth muscle electrical Potentials recorded from surface electrodes.Med.Biol.Eng. 1975, 13(1):97-103
33 Riezzo G, Marisa C, Guerrav, et al. Comparison of gastric electrical activity and gastric empting in healthy and dyspep- tic children. Dig Dis Sci. 2000, 45(3):517
34 Defilippi C, Madrid AM, Defilippi C. Cutaneous electrogas- trography: a new incorporated technique for the study of gastric motility. RevMedChil. 2002, 130(11):1209-1216
35 罗金燕,朱有玲,王学勤等.胃电图和胃排空检测的临床价值评价.胃肠病学.2000, 5(4):223-226
36 Chen J D, Lin z, Panl, et al. Abnormal gastric myoelectrical and debuyed gastric emptying in patients with symptoms suggestive of gastroparesis. Dig Dis Sci. 1996, 41(8): 1538- 1545
37 杨春敏,周吕,徐文杰等.糖尿病胃轻瘫病人胃电图与胃排空的关系.基础医学与临床.1998, 18(14):63-67
38 唐红卫, 刘莉, 黄裕新等.功能性消化不良胃电图与胃排空 检 测 的 同 步 研 究 . 第 四 军 医 大 学 学 报 .2003, 24(19):1783-1786
39 王居峰,李利安,张谢夫等.胃癌患者胃排空的研究.河南肿瘤学杂志.1999, 12(2):112-113
40 陈肯,崔淑兰,袁孟彪等.慢性萎缩性胃炎和胃癌病人的胃排空研究.实用癌症杂志.1995, 10(2):111-113
2 Berezin I, Huizingz JD, Daniel EE. Interstitial cell of Cajal inthe canine colon: a special communication network at the inner border of the circular muscle. J Comp Neurol, 1988, 273(1):42-51
3 Verhagen MAMT, Van Schelven LJ, Samsom M, et al. Pitfalls in the analysis of electrogastrographic recordings. Gastroenterology, 1999, 117(2):453-460
4 Chen JC, McCallum RW. Clinical applications of electro- gastrography. Am J Gastroenterol, 1993, 88(9):1324-1336
5 Lin ZY,Chen JDZ,Stella P, et al. Prevalence of gastric myoelectrical abnomalities in patients with nonulcer dyspepsia and H.pylori infection resolution after H.pylori eradication. Dig Dis Sci, 2001, 46(4):739
6 曹宝花.胃电图及其临床应用.国外医学护理学分册, 2000, 19(6):269
7 罗金艳,朱有玲,王学勤等.胃电图和胃排空检测的临床价值评价.胃肠病学, 2000, 5(4):223-226
8 周吕,柯美云主编.胃肠动力学.基础与临床.第 1 版.北京:科学出版社,1999, 360-366
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11 Chen J, McCallum RW. Gastric slow wave abnormalities in patients with gastroparesis. Am J Gastroenterol, 1992, 87 (4):477-482
12 Yi XB. Electrogastrography: The clinical significance of cha- nges during fasting and postprandial state. Chin J Intern Med, 1991, 30 (6):331-334
13 Verhagen MAMT, Van Schelven LJ, Samsom M, et al. Pitfalls in the analysis of electrogastrographic recordings. Gastroenterology, 1999, 117(2):453-460
14 Chen JC, McCallum RW. Clinical applications of electrogas- trography. Am J Gastroenterol, 1993, 88 (9):1324-1336
15 Levanon D, Zhang M, Chen JDZ. Efficiency and efficacy of the electrogastrogram. Dig Dis Sci, 1998, 43 (5):1023-1030
16 Chang FY, Lee CT, Lee SD, et al. An assembled electr- ogastrography to examine the meal effect on gastric slow wave. J Gastroenterol Hepatol, 1996, 11 (5):506-510
17 Chang FY, Lu CL, Chen CY, et al. Electrogastrographic characteristics in patients of stomach cancer. Dig Dis Sci, 2001, 46(7):1458-1465
18 Chen J, McCallum RW. Electrogastrography: measurement, analysis and prospective applications. Med Biol Eng Comput, 1991, 29 (4):339-350
19 Hermansson G, Sivertsson R. Gender-related differences in gastric emptying rate of solid meals. Dig Dis Sci, 1996, 41(10):1994-1998
20 Parkman HP, Harris AD, Miller MA, et al. Influence of age,gender, and menstrual cycle on the normal electrogastrogram. Am J Gastroenterol, 1996, 91(1):127-133
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23 Giorgio I, Lemaire MC, Pezzola F, et al. Spectral characteris- tics of electrogastrography in gastric cancer. Possibilities of screening. Pathol Biol, 1988, 36(10): 1211-1216
24 Lemaire MC, Pezzola F and Abbattista N, et al. Thouvenot J: Surface electrogastrography (EGG) in cancer: Influence of the localization and tumor characteristics on the spectral components of the signal. Pathol Biol, 1989, 37(1):25-34
25 Hayashi T, Kinami S, Fushida S, et al. Evaluation of residual stomach motility after proximal gastrectomy for gastric canc- er by electrogastrography. Dig Dis Sci,2006,51(2):268-273
26 Pezzolla F, Riezzo G, Maselli MA, et al. Electrical activity recorded from abdominal surface after gastrectomy or collec- tomy in humans. Gastroenterology, 1989, 97(2): 313-320
27 Homma S, Shimakage N, Yagi M, et al. Electrogastrography prior to and following total gastrectomy, subtotal gastrecto- my, and gastric tube formation. Dig Dis Sci, 1995, 40(4): 893-900
28 Imai K, Sakita M. Pre- and postoperative electrogastrographyin patients with cancer gastric. Hepatogastroenterology, 2005, 52(62):639-644
29 Defilippi C, Madrid AM, Defilippi C. Cutaneous electrogas- trography: a new incorporated technique for the study of gastric motility. RevMedChil, 2002, 130(11):1209-1216
30 Chen J D, Lin z, Panl, et al. Abnormal gastric myoelectrical and debuyed gastric emptying in patients with symptoms su- ggestive of gastroparesis. Dig Dis Sci, 1996, 41(8):1538- 1545
31 唐红卫,刘莉,黄裕新等.功能性消化不良胃电图与胃排空检测的同步研究.第四军医大学学报,2003, 24(19): 1783-1786
32 王居峰,李利安,张谢夫等.胃癌患者胃排空的研究.河南肿瘤学杂志,1999,12(2):112-113
33 陈垦,崔淑兰,袁孟彪等.慢性萎缩性胃炎和胃癌病人的胃排空研究.实用癌症杂志,1995, 10(2):111-113
34 Chen J, MaCallum RW. Response of the electric activity in the human stomach to water and solid meal. Med Biol Eug Comput, 1991, 29(4):351-357
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4 Berezin I, Huizingz JD. Daniel EEInterstitial cell of Cajal in the canine colon: a special communication netwoke at the inner border of the circular muscle. Comp.Neurel. 1988,273(1):42-51
5 Smout.AJ,Akkermans. LMA.Motility of the gastrointestinal tract. Wrightson Biomedical Publishing. 1992, 262:41-43
6 曹宝花.胃电图及其临床应用.国外医学护理学分册. 2000,19(6):271
7 Lin X, Chen JD. Abnormal gastric slow waves in patients with functional dyspepsia assessed by multichannel electro- gastrography. Am J Physiol Gastrointest Liver Physiol. 2001, 280(6):1370-1375
8 Lin X, Levanon D, Chen JD. Impaired postprandial gastric slow waves in patients with functionaldyspepsia. Dig Dis Sci. 1998, 43(8):1678-1684
9 蓝宇,柯美云,王智凤等.功能性消化不良患者体表胃电类型及其临床意义.基础医学与临床.2003,23(3):322-327
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11 Mayaudon H, Bauduceau B, Dupuy O, et al. Diabetic auton- omic gastric neuropathy: contribution of the electrogastro- gram. Presse Med. 1999, 28(11):577-579
12 Soykan I, Lin Z, Sarosiek I, et al. Gastric myoelectrical activity Gastric emptying, and correlations with symptoms and fasting blood glucose levels in diabetic patients. Am J Med Sci. 1999, 317(4): 226-231
13 Chen JD, Mccallum RW. The response of electrical activity in normal human stomach to liquid and solid meals. MedicalBiol Eng.Comput. 1991, 29(4):351-357
14 方玲,卞晓红,王红.糖尿病胃轻瘫患者的空腹胃电改变.西北国防医学杂志.2000, 21(2):128-130
15 Nelseh TS. Clinical electrogastrography and its relationship to gastric surgery. Am J Surg. 1968, 116 (2):215-222
16 许冠荪等.胃电图临床应用的初步实验研究.安徽医学院学报.1983, 1:22
17 赖鼎元等.体表胃电图临床应用 456 例的初步探讨.四川医学.1988, 9(2):98-100
18 Lemaire MC, Pezzola F, Abbattista N, et al. Surface electro- gastrography (EGG) in cancer: influence of the localization and tumor characteristics on the spectral components of the signal. Pathol Biol. 1989, 37(1): 25-34
19 Chang FY, Lu CL, Chen CY, et al. Electrogastrographic cha- racterristics in patients of stomach cancer. Dig Dis Sci. 2001, 46(7):1458-1465
20 Pezzolla F, Riezzo G, Maselli MA, et al. Electrical activity recorded from abdominal surface after gastrectomy or collec- tomy in humans. Gastroenterology. 1989, 97(2): 313-320
21 Homma S, Shimakage N, Yagi M, et al. Electrogastrography prior to and following total gastrectomy, subtotal gastric- tomy, and gastric tube formation. Dig Dis Sci. 1995, 40 (4): 893-900
22 Imai K,Sakita M. Pre-and postoperative electrogastrography in patients with cancer gastric. Hepatogastroenterology. 2005, 52(62):639-644
23 Hayashi T, Kinami S, Fushida S, et al. Evaluation of residual stomach motility after proximal gastrectomy for gastric cancer by electrogastrography. Dig Dis Sci. 2006, 51 (2): 268 -273
24 王德山,张立德,柴纪严等.胃癌胃电图特异性波形临床研究.锦州医学院学报.1997, 18(4):7-9
25 陈道志,秦良才,陈莉萍等.胃癌患者四道胃电图特征的观察.中华消化杂志.1997, 17:67-68
26 黄少辉,许冠荪,寇素霞.32 例胃癌患者胃电图特征及分析.安徽中医学院学.1992, 11(2):59-60
27 王德山,冯甲棣,张立德等.胃电图波形与胃、十二指肠疾患关系的研究.中国医科大学学报.1998, 27(2):126-128
28 Lin X, Mellow MH, Southmay DL, et al. Impaired gastric myoelectrical activity in patients with chronic renal failure. Dig Dis Sci. 1997, 42(5):898-906
29 陈艳敏,赵石,范红等.尿毒症患者的体表胃电图研究.华人消化志.1998, 6(11):979-981
30 Chen JD, Pan J, Mccallum RW. Clinical significance of gastric myoelectrical dysrhythmias. Dig Dis Sci. 1995, 13(5): 275-290
31 Chen JD, Ke MY, Lin XM,et al. Cisapride provides symp- tommatic relief in functional dyspepsia associated with gastric myoelectrical abnormality. Aliment Pharmacol Ther. 2000, 14(8):1041-1047
32 Brown BH, Smallwood RH, et al. Intestinal smooth muscle electrical Potentials recorded from surface electrodes.Med.Biol.Eng. 1975, 13(1):97-103
33 Riezzo G, Marisa C, Guerrav, et al. Comparison of gastric electrical activity and gastric empting in healthy and dyspep- tic children. Dig Dis Sci. 2000, 45(3):517
34 Defilippi C, Madrid AM, Defilippi C. Cutaneous electrogas- trography: a new incorporated technique for the study of gastric motility. RevMedChil. 2002, 130(11):1209-1216
35 罗金燕,朱有玲,王学勤等.胃电图和胃排空检测的临床价值评价.胃肠病学.2000, 5(4):223-226
36 Chen J D, Lin z, Panl, et al. Abnormal gastric myoelectrical and debuyed gastric emptying in patients with symptoms suggestive of gastroparesis. Dig Dis Sci. 1996, 41(8): 1538- 1545
37 杨春敏,周吕,徐文杰等.糖尿病胃轻瘫病人胃电图与胃排空的关系.基础医学与临床.1998, 18(14):63-67
38 唐红卫, 刘莉, 黄裕新等.功能性消化不良胃电图与胃排空 检 测 的 同 步 研 究 . 第 四 军 医 大 学 学 报 .2003, 24(19):1783-1786
39 王居峰,李利安,张谢夫等.胃癌患者胃排空的研究.河南肿瘤学杂志.1999, 12(2):112-113
40 陈肯,崔淑兰,袁孟彪等.慢性萎缩性胃炎和胃癌病人的胃排空研究.实用癌症杂志.1995, 10(2):111-113