Transthoracic vagotomy for postoperative peptic ulcer. Effects on basal, sham feeding- and pentagastrin-stimulated acid secretion, and on clinical outcome.
Transthoracic vagotomy for postoperative peptic ulcer. Effects on basal, sham feeding- and pentagastrin-stimulated acid secretion, and on clinical outcome.
复制标题
经胸迷走神经切断术治疗术后消化性溃疡。
DOI：
10.1097/00000658-198505000-00015
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发表时间：
1985
影响因子：
9
通讯作者：
Feldman,M
中科院分区：
文献类型：
--
作者：
Thirlby,RC;Feldman,M
对16例术后经内镜确诊的消化性溃疡患者行经胸迷走神经切断术。10例患者在既往手术中曾尝试经腹迷走神经切断术。5例患者既往接受过胃大部切除术（未行迷走神经切断术），1例患者接受过胃空肠吻合术（未行迷走神经切断术）。16例患者中有3例既往未行胃切除术。经胸迷走神经切断术前，每例患者的假喂食刺激酸输出量（SAO）与五肽胃泌素刺激酸输出量（PAO）峰值的比值均大于0.10，表明胃的迷走神经支配完整（平均比值：0.44;范围：0.17-0.79）。经胸迷走神经切断术后，SAO和PAO分别下降98 +/- 1%和73 +/-8%。无手术死亡，仅1例患者发生临床重要的术后并发症。2例患者出现短暂性胃排空延迟，3例出现腹泻。在平均3.9年（范围：1.0-7.5年）的随访期内，没有患者发生复发性消化性溃疡或溃疡并发症。这项研究表明：（1）假进食有助于确定是否需要进行经胸迷走神经切断术的患者;（2）无论既往是否进行过手术，经胸迷走神经切断术都是一种安全有效的减少胃酸分泌和预防消化性溃疡复发的方法。
Transthoracic vagotomy was performed in 16 patients with postoperative peptic ulcer diagnosed by endoscopy. Transabdominal vagotomy had been attempted at a previous operation in 10 patients. Five patients had been treated previously by subtotal gastrectomy without vagotomy and one had had gastrojejunostomy without vagotomy. Three of the 16 patients had had no previous gastric resection. Before transthoracic vagotomy, the ratio of sham feeding-stimulated acid output (SAO) to peak pentagastrin-stimulated acid output (PAO) was greater than 0.10 in each patient, suggesting intact vagal innervation of the stomach (mean ratio: 0.44; range: 0.17-0.79). After transthoracic vagotomy, SAO and PAO decreased by 98 +/- 1% and 73 +/- 8%, respectively. There was no operative mortality, and a clinically important postoperative complication developed in only one patient. Two patients had delayed gastric emptying transiently, and three have developed diarrhea. No patient has developed recurrent peptic ulceration or ulcer complications during a mean follow-up period of 3.9 years (range: 1.0-7.5 years). This study indicates that: (1) sham feeding is useful for identifying patients to undergo transthoracic vagotomy, and (2) transthoracic vagotomy is a safe and effective means of reducing acid secretion and preventing peptic ulcer recurrence, regardless of previous operation.