Herrington J L, Scott H W, Sawyers J L
Ann Surg. 1984 May;199(5):590-7. doi: 10.1097/00000658-198405000-00014.
Gastroduodenostomy (Billroth I) is our reconstruction of choice following gastric resection for gastroduodenal ulcer. Dissatisfaction with a Billroth II anastomosis has led us in recent years to employ a Roux-en-Y diversion in selected cases, particularly those in which the pathologic state of the pyloroduodenal canal would render a Billroth I anastomosis unsafe. During the past 7 years, truncal vagotomy-antrectomy and Roux-en-Y (VARY) has been carried out in 50 selected patients: duodenal ulcer (DU) 13 patients, gastric ulcer (GU) 11 patients, and stomal ulcer (SU) 26 patients. Fourteen patients (28%) developed postoperative complications, of which nine (18%) were of major degree and five (10%) of a lesser degree. No hospital death occurred among the 50 patients. Five patients (10%) developed postoperative delayed gastric emptying and two of the five required revision of the Roux. Forty-five patients had no clinical problems with delayed emptying. Overall results showed a Visick grading of I in 72%, Visick II in 24%, and Visick III in 4%. Further analysis revealed that of the 13 patients with DU who had VARY, 62% were Visick I, 30% Visick II, and 8% Visick III. The 11 GU patients with VARY were graded Visick I 73% and Visick II 27%. Of 26 patients with SU who underwent VARY, 77% were Visick I, 19% Visick II, and 4% Visick III. Mild to moderate dumping took place in 8% of the 50 patients, mild diarrhea 10%, weight loss 10%, and no patient experienced alkaline reflux gastritis. Long-range postoperative gastric emptying studies among nine patients using a radionuclide revealed varying patterns of emptying. Overall clinical results have been satisfactory and we are continuing to use VARY in selected cases, particularly those in which a Billroth I reconstruction appears contraindicated.
胃十二指肠吻合术（毕罗一世式）是我们对胃十二指肠溃疡行胃切除术后首选的重建方式。近年来，由于对毕罗二世式吻合术不满意，我们在部分病例中采用了 Roux-en-Y 改道术，特别是那些幽门十二指肠管病理状态会使毕罗一世式吻合术不安全的病例。在过去 7 年里，对 50 例选定患者实施了迷走神经干切断术 - 胃窦切除术和 Roux-en-Y 术（VARY）：十二指肠溃疡（DU）患者 13 例，胃溃疡（GU）患者 11 例，吻合口溃疡（SU）患者 26 例。14 例患者（28%）出现术后并发症，其中 9 例（18%）为严重并发症，5 例（10%）为轻度并发症。50 例患者中无医院死亡病例。5 例患者（10%）出现术后胃排空延迟，其中 2 例需要对 Roux 进行修正。45 例患者无胃排空延迟的临床问题。总体结果显示，Visick 分级为 I 级的占 72%，II 级的占 24%，III 级的占 4%。进一步分析发现，13 例行 VARY 的 DU 患者中，62%为 Visick I 级，30%为 Visick II 级，8%为 Visick III 级。11 例行 VARY 的 GU 患者中，73%为 Visick I 级，27%为 Visick II 级。26 例行 VARY 的 SU 患者中，77%为 Visick I 级，19%为 Visick II 级，4%为 Visick III 级。50 例患者中有 8%发生轻度至中度倾倒综合征，10%出现轻度腹泻，10%出现体重减轻，无患者发生碱性反流性胃炎。对 9 例患者进行的放射性核素长期术后胃排空研究显示出不同的排空模式。总体临床结果令人满意，我们将继续在选定病例中使用 VARY，特别是那些毕罗一世式重建似乎禁忌的病例。
