Jordan P H
Ann Surg. 1974 Sep;180(3):259-64. doi: 10.1097/00000658-197409000-00001.
A prospective randomized study of 200 consecutive patients who required elective operation for treatment of duodenal ulcer was conducted. Truncal vagotomy and drainage (V-D) was done in 108 patients with a 2% mortality and truncal vagotomy and antrectomy (V-R) were performed in 92 patients with no mortality. Ninety-four per cent of these patients were followed 5-8 years after operation or until their death if that preceded the termination of the study. The immediate postoperative morbidity including stomal dysfunction and reoperation was greater after V-D than after V-R. In the opinion of the patients and independent investigators, the number of gastrointestinal complaints was similar throughout the study for the two groups of patients. In the opinion of the author, however, more gastrointestinal complaints occurred in patients from the V-R group than from the V-D group. Because of the subjectivity involved in the evaluation of these complaints, it is unknown whether a real difference existed between the two groups of patients. No patient in either group was symptomatically disabled after operation. There were nine recurrent ulcers requiring reoperation after V-D and one after V-R. The insulin test was positive in 58% of patients after V-D and 14% after V-R. These figures were essentially unchanged from those in the first report made three to five years after operation. The basal acid output and the response to histalog stimulation also remained unchanged in the two groups of patients during the same period. This study suggests that if one abstains from resection in patients where technical difficulties with the duodenum can be expected, V-R can be performed in the remaining patients with a mortality rate equally as low as that usually reported for V-D. It is concluded that V-R is superior to V-D for the majority of patients because it is associated with fewer recurrent ulcers without a significant difference in the severity of other postoperative gastrointestinal complaints.
对200例因十二指肠溃疡需择期手术的患者进行了一项前瞻性随机研究。108例患者行迷走神经干切断术加引流术（V-D），死亡率为2%；92例患者行迷走神经干切断术加胃窦切除术（V-R），无死亡病例。这些患者中有94%在术后5 - 8年接受随访，若在研究结束前死亡则随访至死亡。V-D术后包括吻合口功能障碍和再次手术在内的近期术后发病率高于V-R术后。在患者和独立研究者看来，两组患者在整个研究期间胃肠道不适的数量相似。然而，作者认为，V-R组患者出现的胃肠道不适比V-D组更多。由于评估这些不适存在主观性，两组患者之间是否存在真正差异尚不清楚。两组患者术后均无因症状导致的功能障碍。V-D术后有9例复发性溃疡需再次手术，V-R术后有1例。V-D术后58%的患者胰岛素试验呈阳性，V-R术后为14%。这些数字与术后三至五年的首次报告基本相同。同期两组患者的基础胃酸分泌量和对组胺刺激的反应也保持不变。本研究表明，如果对预计十二指肠手术有技术困难的患者不进行切除，那么对于其余患者可以进行V-R手术，其死亡率与通常报道的V-D手术死亡率一样低。得出的结论是，对于大多数患者来说，V-R优于V-D，因为它与较少的复发性溃疡相关，且术后其他胃肠道不适的严重程度无显著差异。
