Ackermann C, Margreth L, Rothenbühler J M, Müller C, Harder F
Departement Chirurgie, Kantonsspital Basel.
Schweiz Med Wochenschr. 1989 May 27;119(21):717-9.
In 109 patients with primary reflux disease in whom combined fundoplication and vagotomy had been performed, the clinical results were evaluated by questionnaire 10-20 years (median 15.7 years) after operation. Indication for additional vagotomy was severe reflux disease and/or increased gastric acid output in 56 (A) and coexistent ulcer disease in 53 (B) patients. Vagotomy was truncular (with pyloroplasty) in 49, selective gastric (with pyloroplasty) in 50, and proximal gastric in 10 patients. Follow-up was available from 64 patients (59.6%). The results were as follows: 17.2% (A 19.4%, B 7.1%) had reflux symptoms, while 9.5% (A 11.4%, B 7.1%) needed medical antireflux therapy. Dysphagia was present in 28.2% (A 13.9%, B 35.7%), and gas-bloat in 54.7% (A 55.5%, B 53.6%). Typical postvagotomy symptoms were diarrhea in 23.5% (A 30.6%, B 14.3%) and dumping in 25.0% (A 22.2%, B 28.6%). Using the Visick classification criteria we found grade I and II in 73.4%, grade III in 17.2% and IV in 9.4%. Symptoms are frequent after fundoplication and vagotomy. The clinical result is more favourable in group B and for the combination of fundoplication with proximal gastric vagotomy.
对109例行胃底折叠术联合迷走神经切断术的原发性反流病患者，在术后10 - 20年（中位时间15.7年）通过问卷调查评估临床结果。56例（A组）患者因严重反流病和/或胃酸分泌增加、53例（B组）患者因并存溃疡病而接受附加迷走神经切断术。49例患者行全胃迷走神经切断术（加幽门成形术），50例患者行选择性胃迷走神经切断术（加幽门成形术），10例患者行近端胃迷走神经切断术。64例患者（59.6%）获得随访。结果如下：17.2%（A组19.4%，B组7.1%）有反流症状，而9.5%（A组11.4%，B组7.1%）需要抗反流药物治疗。吞咽困难发生率为28.2%（A组13.9%，B组35.7%），胃胀发生率为54.7%（A组55.5%，B组53.6%）。典型的迷走神经切断术后症状为腹泻，发生率23.5%（A组30.6%，B组14.3%），倾倒综合征发生率25.0%（A组22.2%，B组28.6%）。根据Visick分类标准，我们发现I级和II级占73.4%，III级占17.2%，IV级占9.4%。胃底折叠术联合迷走神经切断术后症状常见。B组以及胃底折叠术联合近端胃迷走神经切断术的临床结果更有利。
