摘要
目的评价扩大壁细胞迷走神经切断术(EPCV)治疗十二指肠溃疡并发急性穿孔的远期效果.方法对1979-2004年我院239例十二指肠溃疡并发急性穿孔患者施行EPCV术后胃酸分泌功能、并发症发生率、溃疡复发率和VISICK分级等进行了分析.结果239例中随访到203例,随访率为84.9%.全组无手术死亡.术中脾损伤4例(1.7%),粘连性肠梗阻6例(2.5%),突发性腹泻3例(1.3%),进食后上腹胀满18例(7.5%).术后远期并发症有:偶尔上腹痛、返酸16例(7.8%),粘连性肠梗阻4例(1.9%),十二指肠球变型39例(18.2%),慢性胃炎21例(10.3%),复发性溃疡6例(2.9%).术后3～10年基础酸分泌量、最大酸分泌量、高峰酸分泌量分别下降为84.7%、60.0%、58.0%(t=36.584),P＜0.01.结论EPCV术式降酸显著,能有效地降低术后溃疡复发率,做为治疗十二指肠溃疡并发急性穿孔是一种安全、有效的术式.
Objective To evaluate the long-term results of extended parietal cell vagotomy （EPCV） for the treatment of acutely perforated duodenal ulcer. Methods EPCV was performed on 239 patients. Results were analyzed retrospectively. Results Follow up was made on 203 out of 239 patients （84. 9% ）. There was no operative mortality. Inhospital complications included injury to the spleen in 4 cases （ 1.7% ） , adhesive ileus in 6（2. 5% ） , acute diarrhea in 3 （ 1.3% ）, and postprandial epigastric distention in 18 （7. 5% ）. Long-term complications included epigastric pain and sour regurgitation in 16 cases（7.8% ） , enterolysis in 4 （ 1.9% ） , duodenal bulb allaxis in 39 （ 18. 2% ） , chronic gastritis in 21 （ lO. 3% ） , and recurrent ulcer in 6 （ 2. 9% ）. Basic acid output, maximal acid output and peak acid output decreased by 84. 7%, 60. 0%, and 58.0% respectively （ all P 〈 O. O1 ）. Conclusion EPCV is very effective for the treatment of acutely perforated duodenal ulcer. Postoperative gastric acid output is depressed, hence the recurrence of ulcer decreased notably.
出处
《中华普通外科杂志》
CSCD
北大核心
2005年第7期400-402,共3页
Chinese Journal of General Surgery
