Neustein C L, Bushkin F L, Weinshelbaum E I, Woodward E R
Ann Surg. 1977 Feb;185(2):169-74. doi: 10.1097/00000658-197702000-00006.
Between January 1, 1965 and December 31, 1974, 47 patients were treated at the University of Florida Affiliated Hospitals for peptic ulcer after a generally acceptable ulcer operation. Twenty-seven patients had had vagotomy and drainage, four patients had had vagotomy and antrectomy and 16 patients had had partial gastric resection. Forty-nine definitive operations were performed with a 4% operative mortality. Three patients (7%) had another ulcer recurrence following surgery. Left transthoracic vagotomy is the treatment of choice when recurrent ulceration follows subtotal gastrectomy or vagotomy and antrectomy. For ulceration following vagotomy and drainage, antrectomy, antrectomy is preferred. Synergism between hormonal and neural gastric stimulants causes a decreased parietal cell responsiveness to vagal stimulation after antrectomy. Exploration of the hiatus at the time of antrectomy increases the morbidity of the procedure. Should ulcers recur after antrectomy, vagotomy may be performed with a low morbidity through the transthoracic approach.
1965年1月1日至1974年12月31日期间，47例患者在佛罗里达大学附属医院接受了一般可接受的溃疡手术后治疗消化性溃疡。27例患者接受了迷走神经切断术和引流术，4例患者接受了迷走神经切断术和胃窦切除术，16例患者接受了部分胃切除术。共进行了49例确定性手术，手术死亡率为4%。3例患者（7%）术后出现溃疡复发。当溃疡复发发生在胃大部切除术后或迷走神经切断术和胃窦切除术后时，左胸段迷走神经切断术是首选治疗方法。对于迷走神经切断术和引流术后的溃疡，胃窦切除术是首选。胃窦切除术后，激素和神经胃刺激剂之间的协同作用导致壁细胞对迷走神经刺激的反应性降低。胃窦切除术时探查裂孔会增加手术的发病率。如果胃窦切除术后溃疡复发，可通过胸段途径进行迷走神经切断术，发病率较低。
