The surgical physiology of the vagus is reviewed with respect to vagotomy in the treatment of duodenal ulcer. All types of vagotomy (truncal, selective gastric, or proximal gastric) produce similar reduction in acid secretion and comparable elevation in serum gastrin. The evidence is mounting that the vagus may have opposing influences on gastrin release: stimulation and inhibition. Division of only the extragastric vagal branches leads to withdrawal of an inhibitory mechanism rendering the denervated stomach more sensitive to the action of gastrin. The loss of this vagally controlled inhibitory mechanism, rather than more meticulous dissection, may explain the higher incidence of more complete vagotomies in selective than in truncal vagotomy. Proximal gastric vagotomy may be the ideal elective operation yet devised for duodenal ulcer. It does, however, cause elevation in serum gastrin and more than 90 per cent of patients after this operation will have positive insulin test in two to four years. This is higher than the positivity seen with truncal vagotomy. Results of controlled trials are needed before this operation becomes fully established.
本文就迷走神经切断术治疗十二指肠溃疡的手术生理学进行了综述。所有类型的迷走神经切断术（全迷走神经切断术、选择性胃迷走神经切断术或近端胃迷走神经切断术）都会使胃酸分泌减少程度相似，血清胃泌素升高程度相当。越来越多的证据表明，迷走神经可能对胃泌素释放有相反的影响：刺激和抑制。仅切断胃外迷走神经分支会导致一种抑制机制的消除，使去神经支配的胃对胃泌素的作用更敏感。这种由迷走神经控制的抑制机制的丧失，而非更精细的解剖，可能解释了选择性迷走神经切断术中完全性迷走神经切断术的发生率高于全迷走神经切断术的原因。近端胃迷走神经切断术可能是目前为十二指肠溃疡设计的理想择期手术。然而，它确实会导致血清胃泌素升高，并且超过90%接受该手术的患者在两到四年后胰岛素试验会呈阳性。这一阳性率高于全迷走神经切断术。在该手术完全确立之前，需要进行对照试验的结果。
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