Jordan P H, Thornby J
Ann Surg. 1987 May;205(5):572-90. doi: 10.1097/00000658-198705000-00017.
This is a progress report of a prospective, randomized study involving 200 consecutive patients treated electively with either parietal cell vagotomy (PCV) or selective vagotomy and antrectomy (SV-A). Both groups comprised patients with pyloric, prepyloric, or duodenal ulcers. There was no operative mortality in either group. Patients were examined at 2, 6, 12 months, and every 12 months thereafter for 8-10 years. The two operations produced no statistical difference in the frequency of diarrhea. Dumping (p less than 0.0005) and weight loss (p less than 0.0005-p less than 0.05) were statistically less after PCV than after SV-A. There were two recurrent ulcers (2.2%) after SV-A. One was treated successfully by medical therapy and one patient suspected of having gastrinoma had total vagotomy. Nine patients had recurrent ulcers in the PCV group for an accumulated recurrence rate of 10.1% at 10 years by life-table analysis. There was a significant difference (p less than 0.033) between the curves for recurrent ulcers in the two groups of patients. The recurrent ulcer rate after PCV was 21% for patients with pyloric and prepyloric ulcers and 6% for patients with duodenal ulcer. There was no significant difference between the recurrent ulcer rate for PCV and SV-A if the patients with pyloric and prepyloric ulcers were withdrawn from the study. Of the nine patients with recurrent ulcers in the PCV group, three had an inadequate vagotomy and four had a pyloric or prepyloric ulcer before operation. Three patients were successfully treated with antrectomy. Five patients were treated successfully by medical therapy and remained healed for long periods without recurrence. One patient had five recurrences. He declined operation and remained free of symptoms for 3 years after his last recurrence. Poor gastric emptying necessitated gastroenterostomy in five patients in the SV-A group and in one patient in the PCV group. Patients' clinical results were evaluated according to a simple Visick grading scale. A significantly (p less than 0.0005) greater number of patients were in Visick I category after PCV than after SV-A. The clinical results obtained with PCV make this the operation of choice for the elective surgical treatment of duodenal ulcers even though the results obtained with SV-A were good.
这是一项前瞻性随机研究的进展报告，该研究纳入了200例连续接受壁细胞迷走神经切断术（PCV）或选择性迷走神经切断术加胃窦切除术（SV-A）的择期治疗患者。两组均包括幽门、幽门前或十二指肠溃疡患者。两组均无手术死亡病例。患者在术后2、6、12个月接受检查，此后每12个月检查一次，持续8 - 10年。两种手术在腹泻发生率上无统计学差异。与SV-A相比，PCV术后倾倒综合征（p<0.0005）和体重减轻（p<0.0005 - p<0.05）在统计学上更少。SV-A术后有2例复发性溃疡（2.2%）。1例经药物治疗成功，1例疑似胃泌素瘤患者接受了全迷走神经切断术。PCV组有9例复发性溃疡，经寿命表分析，10年累计复发率为10.1%。两组患者复发性溃疡曲线之间存在显著差异（p<0.033）。PCV术后，幽门和幽门前溃疡患者的复发性溃疡率为21%，十二指肠溃疡患者为6%。如果将幽门和幽门前溃疡患者排除在研究之外，PCV和SV-A的复发性溃疡率无显著差异。PCV组9例复发性溃疡患者中，3例迷走神经切断不完全，4例术前有幽门或幽门前溃疡。3例患者行胃窦切除术成功治疗。5例患者经药物治疗成功，长期愈合无复发。1例患者复发5次。他拒绝手术，最后一次复发后3年无症状。SV-A组5例患者和PCV组1例患者因胃排空不良需要行胃肠吻合术。根据简单的Visick分级量表评估患者的临床结果。与SV-A相比，PCV术后处于Visick I级的患者数量显著更多（p<0.0005）。尽管SV-A的治疗效果良好，但PCV获得的临床结果使其成为十二指肠溃疡择期手术治疗的首选术式。
