Schuricht A L, Gowen G F, Azurin D J
Department of Surgery, Pennsylvania Hospital, Philadelphia 19107, USA.
Am Surg. 1997 Jun;63(6):540-2.
Patients who have had prior subdiaphragmatic dissection with an incomplete vagotomy or Nissen fundoplication present added challenges when they require vagotomy and gastric resection. In this setting, thoracoscopic vagotomy offers significant advantages. A second attempt at vagotomy in a previously dissected field can be prolonged and frustrating. In addition to these concerns, repeat dissection can also lead to failure to find the vagal trunks, perforation of the esophagus, hemorrhage, and/or splenic injury. In our experience, three patients requiring gastrectomy or resection of a marginal ulcer have undergone thoracoscopic vagotomy at the time of transabdominal gastric surgery. The thoracoscopic approach avoided either a thoracoabdominal incision or combined thoracic and abdominal incisions while allowing dissection of the vagal trunks to be performed in normal tissue planes. The minimally invasive approach afforded decreased postoperative pain and excellent clinical results. Thoracoscopic vagotomy offers a welcome alternative to re-exploration of a previously dissected distal esophagus in search of vagal trunks, especially when they have been missed at the time of the first operation. Further application of this approach is recommended.
曾接受过膈下剥离术且迷走神经切断不完全或行尼氏胃底折叠术的患者，在需要进行迷走神经切断术和胃切除时会面临更多挑战。在这种情况下，胸腔镜迷走神经切断术具有显著优势。在先前已解剖过的区域再次尝试进行迷走神经切断术可能耗时且令人沮丧。除了这些问题外，再次解剖还可能导致无法找到迷走神经干、食管穿孔、出血和/或脾脏损伤。根据我们的经验，有三名需要进行胃切除术或切除边缘性溃疡的患者在经腹胃手术时接受了胸腔镜迷走神经切断术。胸腔镜手术方法避免了胸腹联合切口或胸腹部联合切口，同时允许在正常组织平面内解剖迷走神经干。这种微创方法减轻了术后疼痛，并取得了良好的临床效果。胸腔镜迷走神经切断术为重新探查先前已解剖过的远端食管以寻找迷走神经干提供了一种受欢迎的替代方法，尤其是在首次手术时遗漏了迷走神经干的情况下。建议进一步应用这种方法。
