高选择性胃迷走神经切断术加保留幽门的胃窦粘膜切除术的应用  

Long-term clinical results after highly selective vagotomy plus pylorus-preserved mucosal antrectomy

作　　者：余佩武[1] 王代科[1] 蔡志民[1] 文亚渊 

机构地区：[1]第三军医大学西南医院普通外科,重庆400038

出　　处：《中华外科杂志》2002年第9期650-652,共3页Chinese Journal of Surgery

摘　　要：目的　观察高选择性胃迷走神经切断术加保留幽门的胃窦粘膜切除术 (HSV +PPMA)治疗十二指肠溃疡的远期疗效。　方法　对 1 987年以来实施该手术后 8～ 1 4年的 34例患者进行了临床随访分析。　结果　全组无手术死亡病例 ,临床属Visick分级Ⅰ～Ⅱ级者占 94 1 %。术后胃酸分泌及胃窦粘膜幽门螺杆菌感染率较术前有显著降低。血清胃泌素水平术后虽然较术前有所降低 ,但差异无显著性意义。术后胃液胆酸和细菌含量较术前相比无显著变化。胃排空均正常 ,X线钡餐和胃镜检查未发现溃疡复发。　结论　HSV +PPMA不仅能有效降低胃酸分泌 ,减少溃疡复发 ,而且能保存胃窦和幽门功能 ,防止术后胆汁反流和胃内细菌过度繁殖 ,是一种治疗十二指肠溃疡较理想的术式。Objective To study the long term clinical results of 34 chronic duodenal ulcer patients treated with high selective vagotomy plus pylorus preserved mucosal antrectomy (HSV+PPMA). Methods Clinical follow up results of the patients from 8～14 years were analyzed. Results Thirty tow patients(94 1%) followed up for 8～14 years after operation achieved Visick grades Ⅰ Ⅱ. No patient died. Gastric acid secretion and infection rate of Helicobacter pylori in the antral mucosa were significantly reduced after operation. No significant difference was found in bile acids, total bacterial counts in gastric juice, and the level of serum gastrin after operation. Gastric emptying was normal. No ulcer recurrence was found by barium meal and endoscopy. Conclusions HSV+PPMA is a better operative treatment for duodenal ulcer, which not only can decrease acid secretion and ulcer recurrence rate but also can preserve the function of antrum and pylorus and prevent post operation bile reflux and intragastric bacterial overgrowth.

关 键 词：胃窦粘膜切除术 迷走神经切断术 十二指肠溃疡 胃酸 促胃液素 胆酸 幽门保留 HSV PPMA 

分 类 号：R656.62[医药卫生—外科学]