Emås S, Grupcev G, Eriksson B
Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
Ann Surg. 1993 Jan;217(1):6-14. doi: 10.1097/00000658-199301000-00003.
In a consecutive series of patients with uncomplicated prepyloric, pyloric, or duodenal ulcer, 39 patients were randomly allocated to selective proximal vagotomy with pyloroplasty, and 40 patients to selective proximal vagotomy alone with no operative mortality. Before surgery, all patients had undergone H2-receptor antagonist treatment. No patient was lost for follow-up. At an average follow-up of 6 years, recurrent ulcer was recorded in 15% and 20%, respectively, after selective proximal vagotomy with and without pyloroplasty. Three of 14 recurrent ulcers were asymptomatic. Epigastric pain with or without ulcer was significantly less common after selective proximal vagotomy with (13%) than without pyloroplasty (40%). Mild diarrhea or mild dumping was recorded in a few patients. The overall results were very good or good (Visick I or II) in 77% and 55% (significant difference) after vagotomy with and without pyloroplasty, respectively, and in 82% and 58%, if asymptomatic ulcers were graded as Visick I or II results. Of the 27 patients with Visick III or IV results, three patients needed no treatment (asymptomatic ulcers), and 10 patients had no symptoms during medical treatment. Two patients with vagotomy and pyloroplasty and nine with vagotomy alone were reoperated. There were no deaths, and the results were graded as Visick I or II in 10 patients and as Visick III in one patient. The authors conclude that selective proximal vagotomy with pyloroplasty is superior to vagotomy alone for the treatment of prepyloric-pyloric and duodenal ulcer. Recurrent ulcer after vagotomy has a benign course and responds well to ranitidine treatment.
在一系列连续的单纯性幽门前、幽门或十二指肠溃疡患者中，39例患者被随机分配接受选择性近端迷走神经切断术加幽门成形术，40例患者仅接受选择性近端迷走神经切断术，无手术死亡病例。术前，所有患者均接受过H2受体拮抗剂治疗。无患者失访。平均随访6年时，接受和未接受幽门成形术的选择性近端迷走神经切断术后复发性溃疡的发生率分别为15%和20%。14例复发性溃疡中有3例无症状。接受选择性近端迷走神经切断术加幽门成形术（13%）后有或无溃疡的上腹部疼痛明显少于未行幽门成形术者（40%）。少数患者记录有轻度腹泻或轻度倾倒综合征。迷走神经切断术加与不加幽门成形术后总体结果非常好或良好（Visick I或II级）的分别为77%和55%（有显著差异），如果将无症状溃疡分级为Visick I或II级结果，则分别为82%和58%。在27例Visick III或IV级结果的患者中，3例患者无需治疗（无症状溃疡），10例患者在药物治疗期间无症状。2例行迷走神经切断术加幽门成形术的患者和9例仅行迷走神经切断术的患者接受了再次手术。无死亡病例，10例患者结果分级为Visick I或II级，1例患者结果分级为Visick III级。作者得出结论，选择性近端迷走神经切断术加幽门成形术治疗幽门前-幽门和十二指肠溃疡优于单纯迷走神经切断术。迷走神经切断术后复发性溃疡病程良性，对雷尼替丁治疗反应良好。
