McCloy R, Nair R
University Department of Surgery, Manchester Royal Infirmary, United Kingdom.
Yale J Biol Med. 1994 May-Aug;67(3-4):159-66.
Peptic ulcer surgery has been revitalized by the introduction of minimal access techniques for surgery of chronic and perforated peptic ulcer. A wide range of vagotomies, including truncal vagotomy, anterior lesser curve seromyotomy with posterior truncal vagotomy and proximal gastric vagotomy, have been performed laparoscopically. Short-term (two-24 month) follow-up of laparoscopic anterior seromyotomy with posterior truncal vagotomy cases has been promising, but long-term follow-up is required to confirm these early good results. Laparoscopic repair of perforated peptic ulcers has also been described. Initial reports of laparoscopic gastrojejunostomy and Billroth II partial gastrectomy have also appeared. These procedures are technically very demanding and are currently being performed in only a few "centers of excellence" around the world. Cost-benefit analyses of medical treatment with proton-pump inhibitors versus laparoscopic vagotomy are necessary to determine which form of treatment is more economical in the long run. Criteria for patient selection need to be defined and substantiated by audit of outcome.
微创技术应用于慢性和穿孔性消化性溃疡手术，使得消化性溃疡手术得以复兴。多种迷走神经切断术，包括全胃迷走神经切断术、前小弯浆膜下切断术加后干迷走神经切断术以及近端胃迷走神经切断术，均已通过腹腔镜完成。对腹腔镜下前浆膜下切断术加后干迷走神经切断术病例进行的短期（2至24个月）随访结果令人鼓舞，但仍需长期随访以证实这些早期的良好效果。也有关于腹腔镜修复穿孔性消化性溃疡的报道。腹腔镜胃空肠吻合术和毕罗Ⅱ式部分胃切除术的初步报告也已出现。这些手术在技术上要求极高，目前仅在全球少数几个“卓越中心”开展。有必要对质子泵抑制剂药物治疗与腹腔镜迷走神经切断术进行成本效益分析，以确定从长远来看哪种治疗方式更经济。需要通过对治疗结果的审核来明确并证实患者选择标准。
