Braasch J W, Brooke-Cowden G L
Surg Clin North Am. 1976 Jun;56(3):607-13. doi: 10.1016/s0039-6109(16)40936-9.
Partial gastrectomy, truncal vagotomy, pyloroplasty, and gastrojejunostomy, singly and in combination, produce clinical disturbances in gastric reservoir function, gastric emptying, gastric mucosal integrity, small intestinal motility, and small intestinal fluids shifts. Ordinarily, these disturbances are of minor clinical importance and respond readily to conservative management. However, postoperative gastric surgical symptoms are, at times, annoying or disabling to the patient. Some of these clinical states are amenable to surgical treatment, and in others, operative intervention is definitely contraindicated. Therefore, it is important to recognize those syndromes which are amenable to an operative procedure. Alkaline gastritis, a syndrome of postcibal pain and diffuse endoscopic gastritis with or without vomiting of bile, is best treated by vagotomy and Roux-en-Y gastrojejunostomy. The afferent loop syndrome of relief of pain by vomiting and the demonstration of a dilated or tortuous afferent loop is likewise best treated by vagotomy and Roux-en-Y gastrojejunostomy or enteroenterostomy. Efferent loop obstruction causing vomiting and gastric distention requires a revision of the gastrojejunostomy. The dumping syndrome is best treated conservatively for at least a year. If this approach fails, loop reversal at the stoma or conversion of a Billroth II to a Billroth I anastomosis is effective. For postvagotomy diarrhea, loop reversal in the distal jejunum gives relief, and for the postvagotomy atonic stomach, a subtotal gastrectomy should be performed after failure of conservative management, although there is not enough experience with this condition to make accurate prognoses. Beware of the patient who does not fit any of these syndromes. A poor result is likely to follow attempts at surgical correction.
胃部分切除术、迷走神经干切断术、幽门成形术和胃空肠吻合术，单独或联合使用，都会引起胃储存功能、胃排空、胃黏膜完整性、小肠蠕动和小肠液体转移方面的临床紊乱。通常情况下，这些紊乱在临床上的重要性较小，对保守治疗反应良好。然而，胃手术后的症状有时会使患者感到烦恼或致残。其中一些临床情况适合手术治疗，而在另一些情况下，手术干预绝对是禁忌的。因此，识别那些适合手术治疗的综合征很重要。碱性胃炎是一种餐后疼痛和弥漫性内镜下胃炎伴或不伴胆汁呕吐的综合征，最好通过迷走神经切断术和Roux-en-Y胃空肠吻合术治疗。通过呕吐缓解疼痛且显示扩张或迂曲的输入袢的输入袢综合征同样最好通过迷走神经切断术和Roux-en-Y胃空肠吻合术或肠肠吻合术治疗。导致呕吐和胃扩张的输出袢梗阻需要对胃空肠吻合术进行修正。倾倒综合征至少一年内最好采用保守治疗。如果这种方法失败，在吻合口处进行肠袢翻转或将毕罗Ⅱ式改为毕罗Ⅰ式吻合是有效的。对于迷走神经切断术后腹泻，在空肠远端进行肠袢翻转可缓解症状，对于迷走神经切断术后的无张力胃，在保守治疗失败后应进行胃次全切除术，尽管对此情况经验不足，无法做出准确的预后判断。要警惕不符合这些综合征中任何一种的患者。手术矫正尝试可能会导致不良结果。
