Stabile B E
University of California, San Diego, USA.
Curr Opin Gen Surg. 1993:206-15.
Evidence continues to accrue that proximal gastric vagotomy is a safe and effective elective operation for duodenal ulcer. Recurrent ulceration remains the major shortcoming of the procedure but reoperation is rarely required. Laparoscopic surgery for peptic ulcer disease is rapidly evolving with anterior seromyotomy and posterior truncal vagotomy emerging as the elective procedure of choice. Perforated ulcer can also be treated by laparoscopic techniques in some cases. Hemorrhage is often amenable to initial endoscopic control measures, but when surgery is required, a definitive acid-reducing operation should be employed. Ulcerogenic drug use appears to be responsible for an increasing number of emergency interventions for life-threatening peptic ulcer complications, although simple closure of perforation due to such drugs may be sufficient surgical treatment. Long-term follow-up data suggest that there is a real risk increase for gastric remnant cancer development 20 years after partial gastrectomy for peptic ulcer but the value of regular endoscopic screening of patients at risk has not been demonstrated. The long-acting somatostatin analogue, octreotide acetate, has been shown to ameliorate the symptoms of the postoperative dumping syndrome markedly, although the mechanism of action remains largely unknown.
越来越多的证据表明，近端胃迷走神经切断术是治疗十二指肠溃疡的一种安全有效的择期手术。复发性溃疡仍然是该手术的主要缺点，但很少需要再次手术。用于治疗消化性溃疡疾病的腹腔镜手术正在迅速发展，前壁浆膜肌层切开术和后壁迷走神经干切断术已成为首选的择期手术。在某些情况下，穿孔性溃疡也可以通过腹腔镜技术进行治疗。出血通常可以通过初步的内镜控制措施来处理，但当需要手术时，应采用确定性的抑酸手术。致溃疡药物的使用似乎导致了越来越多针对危及生命的消化性溃疡并发症的紧急干预，尽管因这类药物导致的穿孔单纯缝合可能就是足够的手术治疗。长期随访数据表明，消化性溃疡行胃部分切除术后20年发生残胃癌的实际风险增加，但尚未证实对有风险的患者进行定期内镜筛查的价值。长效生长抑素类似物醋酸奥曲肽已被证明能显著改善术后倾倒综合征的症状，但其作用机制在很大程度上仍不清楚。
