改良式高选迷切术在十二指肠溃疡并多次急性穿孔中的应用

Modified highly selective vagotomy in duodenal ulcer and many times acute perforation

目的探讨改良式高选迷切术即胃小弯前壁浆膜肌层切开加后迷走神经切断(ASPTV)在十二指肠溃疡并多次急性穿孔治疗中的价值。方法回顾性分析43例十二指溃疡并多次急性穿孔患者术中采用穿孔修补加ASPTV手术的临床资料,讨论其临床应用的意义。结果曾因十二指肠溃疡穿孔行过一次穿孔修补术后再次穿孔35例,行过二次穿孔修补术后再次穿孔9例。全组病例均行穿孔修补加ASPTV手术。手术时间平均(60±15)min,术中出血(200±50)ml左右。术中切破胃黏膜2例,均经修补愈合,术后8例出现胃饱胀感,经对症处理症状消失,无胃排空障碍,未出现手术死亡病例。术后6～12个月胃镜复查41例,溃疡病灶均愈合.无胃潴留。41例随访2～8年(平均5年),术后溃疡复发1例(2.3%),改行胃大部分切除后治愈。结论 ASPTV术式简捷、安全有效、手术创伤小,适合十二指肠溃疡并多次急性穿孔的治疗。

Objective To explore improved selection of high gastric vagotomy in the serosal muscle layer incision with curved front wall after vagotomy （ ASPTV ） in the treatment of acute perforated duodenal ulcer and many in value. Methods We retrospctively analyzed 43 patients with duodenal ulcer and acute perforation of several patients with intraoperative perforation repair surgery plus ASPTV information, discuss its clinical significance. Results Because duodenal ulcer and perforation, it perforated once again after repair in 35 cases, the second line had another perforation perforation repair surgery in 9 cases. All the patients underwent surgical repair of perforation increases ASPTV. The average operation time was （60 ± 15）min, blood loss was （200 ±50）ml or so. Cut broken gastric surgery, 2 cases were healed by repair, 8 cases of gastric fullness after flu symptoms by symptomatic treatment and no delayed gastric emptying, no surgical deaths occurred. Review 6 - 12 months after endoscopy in 41 cases, ulcer lesions healed without gastric retention. 41 cases were followed up for 2 - 8 years （mean 5 years）, postoperative ulcer recurrence in 1 case （2.3%）, diverted to cure after gastrectomy. Conclusion ASPTV operative methods is simple, safe and effective, small surgical creation, fitting for treatment of duodenal ulcer and many times acute perforation.