十二指肠溃疡及其并发症的高选择性迷走神经切断术。一项为期12年的回顾。
Highly selective vagotomy in duodenal ulceration and its complications. A 12-year review.
作者信息
Gorey T F, Lennon F, Heffernan S J
出版信息
Ann Surg. 1984 Aug;200(2):181-4. doi: 10.1097/00000658-198408000-00011.
Highly selective vagotomy (HSV) was performed in 509 patients over 12 years for the surgical management of duodenal ulceration; 103 HSVs were carried out during the treatment of complications. The overall rate of ulcer recurrence was 7%, ranging from 10% in the first 4 years to 4% in the 6 years between 1975 and 1980. Highly selective vagotomy was performed in addition to closure of a perforated ulcer in 16 patients, with no recurrent ulcers or re-perforations. After the control of their bleeding duodenal ulcers, 25 patients had HSV with no rebleeding, although two patients had recurrent ulceration. Highly selective vagotomy was performed in 62 patients with stenosis in addition to dilatation (44) or duodenoplasty (18). There was a high incidence of recurrent ulceration (7) and stenosis (9) with digital dilatation while duodenoplasty gave better results with one recurrent stenosis and no recurrent ulceration. The authors conclude that HSV is justified by its late results as a definitive operation in chronic duodenal ulceration that allows preservation of the pylorus during surgery for complications.
在12年期间，对509例患者实施了高选择性迷走神经切断术（HSV）用于十二指肠溃疡的手术治疗；在并发症治疗期间实施了103例HSV。溃疡复发的总体发生率为7%，最初4年为10%，1975年至1980年的6年间为4%。16例患者在穿孔性溃疡闭合术之外还实施了高选择性迷走神经切断术，无溃疡复发或再次穿孔情况。25例十二指肠溃疡出血得到控制的患者接受了HSV，无再次出血情况，不过有2例患者出现溃疡复发。62例伴有狭窄的患者在扩张术（44例）或十二指肠成形术（18例）之外还实施了高选择性迷走神经切断术。手指扩张术导致溃疡复发（7例）和狭窄（9例）的发生率较高，而十二指肠成形术效果更佳，仅有1例复发性狭窄，无溃疡复发。作者得出结论，作为慢性十二指肠溃疡的确定性手术，HSV因其后期效果而合理，在针对并发症的手术过程中可保留幽门。
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