Jordan P H
Ann Surg. 1979 May;189(5):643-53. doi: 10.1097/00000658-197905000-00015.
This is an interim report of a prospective, randomized study involving 194 consecutive patients who underwent elective operation for treatment of duodenal ulcer. The results of parietal cell vagotomy without drainage (PCV) and selective vagotomy-antrectomy and Billroth I anastomosis (SV-A-B I) were compared. There was no mortality. Postoperatively patients were examined at two, six, 12 months and every 12 months thereafter. The two operations showed no statistical difference in the frequency of diarrhea. Dumping was less (p < .01) after PCV than after SV-A-B I. Weight loss was less (p < .01) after PCV than after SV-A-B I. There were no recurrent ulcers after SV-A-B I and five after PCV. In each instance but one the recurrent ulcer healed on withdrawal of an ulcerogenic drug. One patient required reoperation. Reoperations in the PCV group consisted of one for recurrent ulcer, one for gastric outlet obstruction and three for intestinal obstruction. The reoperations after SV-A-B I consisted of four for gastric outlet obstruction, three for intestinal obstruction, one for ruptured spleen and two for incisional hernia. PCV was technically feasible and practical to perform except in the occasional patient with severe pyloric stenosis. Obesity was never a deterrent. After PCV it is reasonable to assume that a recurrent ulcer rate in the range of 5-10% can be expected by surgeons who have been properly trained. This recurrence rate is higher than that after SV-A-B I but no higher than that encountered with TV-P. The recurrence rate is acceptable and is a fair exchange for the avoidance of dumping and weight loss that accompany SV-A-B I with significantly greater frequency and which on occasion can produce gastric crippling, although this did not occur in this study. All recurrent ulcers after PCV do not require reoperation but when operative treatment is required the patient has all the options that he had prior to PCV.
这是一项前瞻性随机研究的中期报告，该研究纳入了194例连续接受择期手术治疗十二指肠溃疡的患者。比较了不做引流的壁细胞迷走神经切断术（PCV）与选择性迷走神经切断术-胃窦切除术及毕罗一世吻合术（SV-A-B I）的结果。无死亡病例。术后患者在2个月、6个月、12个月时接受检查，此后每12个月检查一次。两种手术在腹泻发生率上无统计学差异。PCV术后倾倒综合征的发生率低于SV-A-B I（p <.01）。PCV术后体重减轻低于SV-A-B I（p <.01）。SV-A-B I术后无复发性溃疡，PCV术后有5例。除1例复发性溃疡在停用致溃疡药物后愈合外，其余复发性溃疡均愈合。1例患者需要再次手术。PCV组的再次手术包括1例因复发性溃疡、1例因胃出口梗阻和3例因肠梗阻。SV-A-B I术后的再次手术包括4例因胃出口梗阻、3例因肠梗阻、1例因脾破裂和2例因切口疝。除偶尔有严重幽门狭窄的患者外，PCV在技术上是可行且实际可行的。肥胖从来都不是阻碍因素。PCV术后，经过适当培训的外科医生可以合理预期复发性溃疡发生率在5%-10%之间。该复发率高于SV-A-B I术后，但不高于经电视辅助腹腔镜胃大部切除术（TV-P）后的复发率。该复发率是可以接受的，并且是为避免SV-A-B I术后更频繁出现的倾倒综合征和体重减轻所做的合理权衡，尽管本研究中未出现倾倒综合征导致胃功能严重受损的情况，但有时倾倒综合征会导致胃功能严重受损。PCV术后所有复发性溃疡并非都需要再次手术，但当需要手术治疗时，患者拥有PCV术前的所有选择。
