Tondelli P, Grötzinger U, Müller C
Schweiz Med Wochenschr. 1984 May 19;114(20):693-9.
Historically, surgery for peptic ulcer has seen the evolution of differing operative principles: resection, vagotomy (truncal, selective, highly selective), and a combination of vagotomy and resection (antrectomy). The long-term effects of the various operations can now be evaluated from several published studies. Though vagotomy and antrectomy is the most "efficient" operation (ulcer recurrence rate 1%), it has the highest morbidity (15-20%) and mortality (1.5-2%); while highly selective vagotomy is the least "efficient" operation (ulcer recurrence rate 10%), it has the lowest morbidity (5%) and mortality (less than 0.5%). In the future, reduced recurrence rates should be possible by improving surgical technique and by better selection of the operative procedure (on the basis of a better selection of the operative procedure (on the basis of a better understanding of ulcer pathogenesis), but without sacrificing the advantages of highly selective vagotomy--low morbidity and mortality--for the majority of patients. Intraoperative testing of the completeness of vagotomy, and addition of a drainage such as pyloroplasty or antrectomy for juxtapyloric ulcers, may help to achieve this goal.
从历史上看，消化性溃疡手术经历了不同手术原则的演变：切除术、迷走神经切断术（全胃迷走神经切断术、选择性迷走神经切断术、高选择性迷走神经切断术）以及迷走神经切断术与切除术的联合（胃窦切除术）。现在可以从几项已发表的研究中评估各种手术的长期效果。虽然迷走神经切断术加胃窦切除术是最“有效”的手术（溃疡复发率为1%），但其发病率最高（15 - 20%），死亡率也最高（1.5 - 2%）；而高选择性迷走神经切断术是最不“有效”的手术（溃疡复发率为10%），但其发病率最低（5%），死亡率也最低（低于0.5%）。未来，通过改进手术技术以及更好地选择手术方式（基于对溃疡发病机制的更好理解），有可能降低复发率，但对于大多数患者而言，不能以牺牲高选择性迷走神经切断术低发病率和低死亡率的优势为代价。术中对迷走神经切断术完整性的检测，以及为近幽门溃疡添加诸如幽门成形术或胃窦切除术等引流术，可能有助于实现这一目标。
