摘要
报告用改良Golisher高选择性迷走神经切断术治疗球部溃疡100例、复合性溃疡79例及伴出血、梗阻、穿孔的球部溃疡38例,疗效满意,随访3~20年,并发症少,复发率<2%,按Visick分级优良率84%。作者认为:正确选择适应证;术中除保留鸦爪支、肝胆腹腔支、迷走神经主干外,应剥光食管下端5~7cm,完全切断前后主干向胃发出的分支和角切迹对应大弯侧胃网膜血管8~10cm。操作仔细、规范,防止遗漏是手术成功的关键。对复发病例的再手术要针对梗阻、复发溃疡合理选择术式,高选择性迷走神经切断术加胃窦粘膜切除术是较为理想的术式,复发率更低,效果好。
Modified Goligher’s highly selective vagotomy(HSV)for 217 cases of duodenal ulcers is reported.In this series they were:duodenal ulcer(100 cases),combined gastric and duodenal ulcers(79 cases)and complicated perforating,bleeding or stenosed ulcers(38 cases).In the complicated duodenal ulcer,HSV was usually carried out with suturing bleeding point,perforated ulcer or with pyloroplasty.With a follow-up of 3~20 years,the recurrence rate were<2%and 85.7%of cases had excellent or good results as Visick classification.Considerations relevant to the HSV technic are deemed worthy of emphasis;complete resection of gastric branches of anterior and posterior vagal trunks and preservation of the first limb of the"Crow’s foot",extended dissection of the distal 5-7cm of the esophagus and division of the distal 8-10cm of the bundle of the gastroepiploic vessels in order to deprive the whole parietal cell mass of its vagal supply.In 4 patients,recurrence were easily controlled with remedies or operation for gastric retention by rational type.The authors suggest that the modified HSV plus mucusdeprived antrectomy be the rational surgical choice for duodenal ulcer.
作者
王文龙
郑英键
李庆友
全国梁
高法仁
李泽民
Wang Wenlong;Zheng Yinjian;Li Qinyou(Department of General Surgery,Wuhan Second Municipal Hospital,Wuhan 430014)
关键词
迷走神经切断术
十二指肠球部
溃疡
复发
Highly selective vagotomy
Duodenal ulcer
Recurrence
Mucus-deprived Antrectomy
