Stenquist B, Forssell H, Olbe L, Lundell L
Department of Surgery, Sahlgren Hospital, University of Gothenburg, Sweden.
Br J Surg. 1994 Jul;81(7):1002-6. doi: 10.1002/bjs.1800810724.
The completeness of vagal denervation in determining the long-term outcome of patients with duodenal ulcer disease after proximal gastric vagotomy (PGV) was studied by examining the relationship between the postoperative acid secretory response to sham feeding ('chew and spit' technique) and the subsequent ulcer recurrence rate during a mean follow-up of 7.5 (range 5-15) years. The cumulative recurrence rate of 98 patients analysed prospectively was 11 per cent. Of 22 patients who had incomplete vagotomy as suggested by the sham feeding response, five had a later relapse. This compares with only an 8 per cent relapse rate among those with a secretory response suggesting complete vagotomy. Four patients suffered from a relapse more than 5 years after operation but none had undergone incomplete vagotomy. However, in seven patients with an early postoperative relapse (within 5 years) five had had incomplete vagal denervation (P < 0.05). In this latter group the median time elapsed from surgery until the first recurrence was only 1 year. It is concluded that the early postoperative acid secretory response to a sham feeding stimulus is clinically useful as it allows prediction of the risk of early relapse after PGV. This test may be helpful for the validation of new techniques of vagotomy.
通过研究近端胃迷走神经切断术（PGV）后，十二指肠溃疡病患者术后对假饲（“咀嚼和吐出”技术）的酸分泌反应与随后平均7.5年（范围5 - 15年）随访期间溃疡复发率之间的关系，探讨迷走神经切断的完整性对十二指肠溃疡病患者长期预后的影响。前瞻性分析的98例患者的累积复发率为11%。假饲反应提示迷走神经切断不完全的22例患者中，5例后来复发。相比之下，分泌反应提示迷走神经切断完全的患者复发率仅为8%。4例患者术后5年以上复发，但均未接受不完全迷走神经切断术。然而，在7例术后早期（5年内）复发的患者中，5例存在不完全迷走神经切断（P < 0.05）。在后一组中，从手术到首次复发的中位时间仅为1年。得出结论，术后早期对假饲刺激的酸分泌反应在临床上是有用的，因为它可以预测PGV后早期复发的风险。该试验可能有助于验证新的迷走神经切断技术。
