Avtan L, Avci C, Arici C, Berber E
Department of Surgery, Medical Faculty of Istanbul University, Turkey.
Hepatogastroenterology. 1996 Nov-Dec;43(12):1689-94.
BACKGROUND/AIMS: This report presents the technique and preliminary results of a prospective trial of videothoracoscopic bilateral truncal vagotomy without a drainage procedure in a series of selected patients having elective surgery for chronic non obstructive duodenal ulcer.
Videothoracoscopic truncal vagotomy was performed in six patients with chronic duodenal ulcer resistant to medical treatment. These patients undergoing neither a drainage nor a dilatation procedure supplementary to bilateral truncal vagotomy were chosen with selective indication regarding the absence of pyloric obstruction and presence of hyperacidity. The results of acid secretory tests and endoscopic control were studied.
A Videothoracoscopic approach to truncal vagotomy was performed simply with a mean operation time of 42 min (35-80) providing all the advantages of minimally invasive surgery such as low morbidity and early recovery. The mean decrease of peak acid output was 77.4% and the ulcer healed without any gastric stasis symptoms or signs as compared with the endoscopic controls at the second month postoperatively. During the mean follow-up period of 26 months (3-38), the only symptom was moderate diarrhea which resolved spontaneously.
Truncal vagotomy by videothoracoscopy as a simple, surgeon independent and efficient procedure seems to be an alternative treatment regimen for the management of chronic duodenal ulcer in a group of selected patients. Instead of routine addition of a drainage procedure after truncal vagotomy which may improve the morbidity, observation of the patient after truncal vagotomy with dietary caution supplementary to prokinetic medication may be the chosen method in today's circumstances.
背景/目的：本报告介绍了一项前瞻性试验的技术和初步结果，该试验对一系列因慢性非梗阻性十二指肠溃疡而接受择期手术的特定患者进行了不进行引流手术的电视胸腔镜双侧迷走神经干切断术。
对6例药物治疗无效的慢性十二指肠溃疡患者进行了电视胸腔镜迷走神经干切断术。这些患者在双侧迷走神经干切断术后既未进行引流手术也未进行扩张手术，选择这些患者是基于无幽门梗阻且胃酸分泌过多的选择性指征。研究了胃酸分泌试验和内镜检查的结果。
采用电视胸腔镜进行迷走神经干切断术操作简便，平均手术时间为42分钟（35 - 80分钟），具有微创手术的所有优点，如发病率低和恢复快。与术后第二个月的内镜检查对照相比，胃酸峰值输出平均下降了77.4%，溃疡愈合且无任何胃潴留症状或体征。在平均26个月（3 - 38个月）的随访期内，唯一的症状是中度腹泻，且自行缓解。
电视胸腔镜迷走神经干切断术作为一种简单、独立于外科医生且有效的手术，似乎是一组特定患者慢性十二指肠溃疡治疗的替代方案。在迷走神经干切断术后，可不常规加做引流手术（引流手术可能会降低发病率），在当今情况下，迷走神经干切断术后对患者进行观察，并谨慎饮食，辅以促动力药物，可能是首选方法。
