Palumbo L T, Sharpe W S
Ann Surg. 1975 Nov;182(5):610-6. doi: 10.1097/00000658-197511000-00013.
Distal antrectomy (25% or less) resection of the distal stomach with bilateral vagectomy, Billroth II, antecolic, Polya or Hofmeister gastrojejunostomy, continues to be our operation of choice for chronic duodenal ulcer. This is based upon our experience in 611 operations and as a result of careful complete repeat in-patient followup studies conducted since our original operation which was devised and performed in July 1953. This procedure controls or eliminates the two major gastric acid stimulatory phases responsible in the pathogenesis and chronicity of a duodenal ulcer: neurogenic (cephalic phase) via the vagel gastric pathways, and the humoral (gastrin) phase via antral stimulation. Even though part of the antrum may remain in the gastric remnant in some patients, antral control is maintained because the antrum remains in the gastric acid stream, there is no stasis, and it is vagectomized. The ulcer diathesis is controlled with a minimal disturbance in gastric physiology, in function, and in gastric reservoir capacity; the procedure will almost eliminate all of the undesirable postoperative gastrointestinal sequelase associated with other operations for duodenal ulcer. It insures the least chance for marginal, gastric, or recurrent ulcer formation, and a low morbidity rate.
远端胃切除术（切除远端胃的25%或更少），行双侧迷走神经切断术，毕罗Ⅱ式，结肠前，波利亚或霍夫迈斯特胃空肠吻合术，仍然是我们治疗慢性十二指肠溃疡的首选手术方式。这是基于我们在611例手术中的经验，以及自1953年7月设计并实施首次手术以来进行的仔细、完整的住院患者随访研究的结果。该手术可控制或消除导致十二指肠溃疡发病机制和慢性化的两个主要胃酸刺激阶段：通过迷走神经-胃途径的神经源性（头期），以及通过胃窦刺激的体液性（胃泌素）阶段。尽管在某些患者中胃窦的一部分可能保留在胃残端中，但由于胃窦仍处于胃酸流中，不存在淤滞且已行迷走神经切断术，因此仍能维持对胃窦的控制。该溃疡素质在对胃生理、功能和胃储容能力的干扰最小的情况下得到控制；该手术几乎能消除与十二指肠溃疡其他手术相关的所有不良术后胃肠道后遗症。它确保了边缘性、胃性或复发性溃疡形成的可能性最小，且发病率较低。
