Ackermann C, Harder F
Departement Chirurgie, Kantonsspital Basel.
Schweiz Med Wochenschr. 1992 Jun 20;122(25):983-7.
The aim of this study was to determine the influence of proximal gastric vagotomy on the outcome after fundoplication. Of 141 patients operated on for reflux disease between 1972 and 1988, 53 had fundoplication alone (group A) and 88 fundoplication combined with proximal gastric vagotomy (group B). The two groups were similar with regard to the severity of the reflux disease (esophagitis: A 69%, B 73%) but had a different incidence of concomitant ulcer disease (A 2%, B 55%). After a mean follow-up of 9 years, 111 patients (79%) were evaluated by clinical examination and 57 patients (40%) by endoscopy. Perioperative morbidity was similar (A 22%, B 19%). Successful reflux control (A and B 81%) and overall clinical outcome (Visick I and II: A 78%, B 80%) were identical. The frequency of adverse side effects was approximately the same in both groups (dysphagia: A 28%, B 26%; gas-bloat: A 52%, B 37%). We conclude that the long term results after fundoplication are not improved by additional proximal gastric vagotomy. The combined procedure is therefore only justified if both reflux disease and ulcer disease are present.
本研究的目的是确定近端胃迷走神经切断术对胃底折叠术后结果的影响。在1972年至1988年间接受反流性疾病手术的141例患者中，53例仅行胃底折叠术（A组），88例行胃底折叠术联合近端胃迷走神经切断术（B组）。两组在反流性疾病的严重程度方面相似（食管炎：A组69%，B组73%），但合并溃疡病的发生率不同（A组2%，B组55%）。平均随访9年后，111例患者（79%）接受了临床检查评估，57例患者（40%）接受了内镜检查评估。围手术期发病率相似（A组22%，B组19%）。反流控制成功率（A组和B组均为81%）和总体临床结果（Visick I级和II级：A组78%，B组80%）相同。两组不良副作用的发生率大致相同（吞咽困难：A组28%，B组26%；气胀：A组52%，B组37%）。我们得出结论，额外的近端胃迷走神经切断术并不能改善胃底折叠术后的长期结果。因此，只有在同时存在反流性疾病和溃疡病的情况下，联合手术才是合理的。
