Petrov V I, Naumov B A, Lutsevich O E, Kotaev A Iu, Belouglov S M
Khirurgiia (Mosk). 1994 Mar(3):8-12.
Various surgical interventions were conducted in the clinic on 63 patients for perforation of pyloric and prepyloric ulcers. Closure of the perforated ulcer was performed in 8 patients, excision of the ulcer and transverse pyloroplasty in 14, truncal and selective vagotomy in combination with antrumectomy in 6, and truncal vagotomy and pyloroplasty in 3 patients. According to the authors, the operation of choice is anterior seromyotomy of the body and fundus of the stomach in combination with posterior truncal or posterior selective vagotomy and obligatory excision of the ulcer for histological study, and transverse pyloroplasty of the Aust-Holle type which was performed in 22 patients. The indications for radical operations were expanded bearing in mind the peculiarities of the course of peritonitis in patients with perforated gastric ulcers. In addition to the traditional prophylactic treatment of the abdominal cavity, the complex treatment of peritonitis included the use of low-frequency ultrasound during the operation and prolonged laparoscopic prophylactic treatment with low-intensity laser beam in the postoperative period.
该诊所对63例幽门及幽门前溃疡穿孔患者实施了多种外科手术干预措施。8例患者进行了穿孔溃疡闭合术，14例进行了溃疡切除术及横断性幽门成形术，6例进行了迷走神经干切断术及选择性迷走神经切断术并联合胃窦切除术，3例进行了迷走神经干切断术及幽门成形术。据作者称，首选的手术方式是胃体和胃底前壁浆膜切开术联合迷走神经干后切断术或迷走神经选择性后切断术，并必须切除溃疡进行组织学研究，以及对22例患者实施奥斯特-霍勒（Aust-Holle）型横断性幽门成形术。考虑到胃溃疡穿孔患者腹膜炎病程的特点，根治性手术的适应证有所扩大。除了传统的腹腔预防性治疗外，腹膜炎的综合治疗还包括术中使用低频超声以及术后进行长时间的低强度激光束腹腔镜预防性治疗。
