Herrington J L, Meacham P W, Hunter R M
Ann Surg. 1982 May;195(5):574-81. doi: 10.1097/00000658-198205000-00006.
Transabdominal fundoplication is an effective operation for control of gastroesophageal reflux in the majority of patients. The operation is, however, associated with several sell-documented early and late complications. Recently, a few reports have appeared describing benign gastric ulceration (GU) occurring from one month to several years postplication. The etiology of GU in this setting is unknown, but preexisting delayed gastric emptying, pyloric incompetence, faulty wrap construction, local ischemia, and trauma to the vagus nerves have been incriminated. During a recent seven-year period, five cases of GU have occurred among a series of 158 patients who underwent fundoplication. The cases are cited in detail, and the recent literature is reviewed. Discussion is addressed to the various proposed factors and combination of factors thought to contribute to GU. Suggestions are included for the preoperative evaluation of patients with gastroesophageal reflux as an aid to intraoperative management. As trauma to the vagus nerves has been frequently mentioned as a contributing factor to postplication ulcer, an operative technique is described in which the vagus nerves are isolated and protected from the fundic wrap.
经腹胃底折叠术是控制大多数患者胃食管反流的有效手术。然而，该手术伴有一些已被充分记录的早期和晚期并发症。最近，有一些报告描述了在折叠术后1个月至数年出现的良性胃溃疡（GU）。这种情况下GU的病因尚不清楚，但既往存在的胃排空延迟、幽门功能不全、折叠结构不当、局部缺血以及迷走神经损伤都被认为与之有关。在最近的7年期间，在158例行胃底折叠术的患者中发生了5例GU。详细列举了这些病例，并对近期文献进行了综述。讨论了各种被认为与GU有关的因素及因素组合。还包括了对胃食管反流患者进行术前评估的建议，以辅助术中管理。由于迷走神经损伤经常被提及是折叠术后溃疡的一个促成因素，本文描述了一种手术技术，即分离迷走神经并使其免受胃底折叠的影响。
