Bahadorzadeh K, Jordan P H
Ann Surg. 1975 Apr;181(4):402-8. doi: 10.1097/00000658-197504000-00006.
Twenty-nine patients who underwent Nissen fundoplication for the treatment of symptomatic, sliding, esophageal hiatal hernia are reported. Fourteen of these patients also underwent parietal cell vagotomy (PCV) without a drainage procedure. Simulatenous cineradiography and manometric studies, esophagoscopy and gastric analysis were performed pre- and postoperatively. Esophageal acid clearing and pH reflux studies were performed postoperatively. All but 3 patients had reflux and/or esophagitis preoperatively. Cineradiography and the pH reflux test were the most reliable tests for diagnosis of reflux. There was no operative mortality. The mean followup period was 20 months. Dysphagia occurred in 5 patients. Correction of dysphagia in one patient required operation. The dysphagia in the remaining patients was temporary and mild, responding to dilatation. Two patients had mild diarrhea. One patient who had had a previous gastric resection developed severe diarrhea after bilateral truncal vagotomy. No patient developed the "bloat syndrome". A close correlation did not exist between reflux and preoperative sphincter pressure. The mean LES pressure increased 10 mmH2O postoperatively and the two patients with persistent reflux postoperatively had normal LES pressure. Correction of reflux after Nissen fundoplication is probably due to some mechanism other than increased LES pressure. Recurrent or persistent hiatal hernia was diagnosed in 4 patients by cineradiography. Two of these patients had reflux but only the patient who had undergone PCV was without symptoms or esophagitis. The technical performance of the Nissen hiatal hernia repair was greatly facilitat ed by PCV. This procedure also provided adequate treatment for patients with concomitant duodenal ulcer disease. PCV, unaccompanied by a drainage procedure, was not associated with increased morbidity, mortality or the adverse effects usually attributed to vagotomy. In the event of recurrent hernia and reflux, PCV may prevent the development of esophagitis.
本文报告了29例因有症状的滑动型食管裂孔疝而接受nissen胃底折叠术治疗的患者。其中14例患者还接受了壁细胞迷走神经切断术（PCV），未进行引流手术。术前和术后均进行了同步食管造影和测压研究、食管镜检查和胃液分析。术后进行了食管酸清除和pH值反流研究。除3例患者外，所有患者术前均有反流和/或食管炎。食管造影和pH值反流试验是诊断反流最可靠的检查方法。无手术死亡病例。平均随访期为20个月。5例患者出现吞咽困难。1例患者吞咽困难的纠正需要手术治疗。其余患者的吞咽困难是暂时的且较轻，经扩张治疗后缓解。2例患者出现轻度腹泻。1例曾行胃切除术的患者在双侧迷走神经干切断术后出现严重腹泻。无患者发生“腹胀综合征”。反流与术前括约肌压力之间不存在密切相关性。术后LES平均压力升高10 mmHg，术后持续反流的2例患者LES压力正常。nissen胃底折叠术后反流的纠正可能是由于LES压力升高以外的某种机制。通过食管造影诊断出4例复发性或持续性裂孔疝。其中2例患者有反流，但只有接受PCV的患者无症状或食管炎。PCV大大促进了nissen裂孔疝修补术的技术操作。该手术也为合并十二指肠溃疡病的患者提供了充分的治疗。未进行引流手术的PCV与发病率、死亡率增加或通常归因于迷走神经切断术的不良反应无关。在复发性疝和反流的情况下，PCV可能预防食管炎的发生。
