Rossetti M, Hitz P
Helv Chir Acta. 1989 Jan;55(5):559-64.
In treating hyperacid gastro-esophageal reflux it is debatable whether or not to combine an antireflux operation with an antipeptic procedure. The problem is controversial as evidenced by the number of operative procedures and the diverse opinions in published reports. We believe that if there is an increased gastric acid secretion the combination of fundoplication and vagotomy is a logical alternative to long-term treatment with H2-receptor antagonists or with the new H+ protone blocker Omeprazol, especially when these conservative measures fail. The superselective vagotomy poses technical problems for it compromises the anchorage of the fundic wrap. On the other hand truncal vagotomy, though technically simpler, is unacceptable because of its associated side effects. As a result we have come to modify our standard technique. We combine a selective denervation of the esophago-gastric junction with a modification to our standard fundoplication procedure, whereby the fundic wrap is drawn forward between the vagal trunks and the lesser gastric curvature. In the last five years we have operated 58 patients in this combined way. We were able to carry out follow-up controls in 32 patients. All of them showed good long-term healing with improvement of reflux symptoms.
在治疗胃酸过多的胃食管反流时，是否将抗反流手术与抗溃疡手术相结合存在争议。从手术方法的数量以及已发表报告中的不同观点可以看出，这个问题颇具争议。我们认为，如果胃酸分泌增加，胃底折叠术和迷走神经切断术相结合是一种合理的选择，可替代长期使用H2受体拮抗剂或新型H⁺质子阻滞剂奥美拉唑进行治疗，尤其是当这些保守措施无效时。超选择性迷走神经切断术存在技术问题，因为它会影响胃底包裹的固定。另一方面，全迷走神经切断术虽然技术上更简单，但由于其相关的副作用而不可接受。因此，我们对标准技术进行了改进。我们将食管胃交界处的选择性去神经支配与对标准胃底折叠术的改良相结合，即胃底包裹在迷走神经干和胃小弯之间向前牵拉。在过去五年中，我们以这种联合方式为58例患者进行了手术。我们对其中32例患者进行了随访控制。所有患者均显示出良好的长期愈合效果，反流症状得到改善。
