修补加近侧胃迷走神经切断术或三联疗法治疗穿孔性十二指肠溃疡

Long-term curative effects of suture plus proximal gastric vagotomy or triad-therapy for duodenal ulcer with acute perforation

目的 对比研究修补术联合近侧胃迷走神经切断术 (proximalgastricvagotomy ,PGV)与修补术联合三联疗法 (口服奥美拉唑加羟氨苄青霉素加灭滴灵 )对穿孔性十二指肠溃疡的远期疗效。方法 32 9例十二指肠溃疡急性穿孔患者非随机地接受了A、B不同的治疗方法。A组 1 53例 ,行修补术联合PGV ;B组 1 76例 ,行修补术联合三联疗法。术后 5～ 8年 ,采用信访、电话访问、门诊复查以及与患者所在当地医院合作调查的方式进行随访。随访内容包括症状问诊、胃镜复查、幽门螺杆菌(HP)检测等。随访结果按Visick标准分级。 结果 获得随访 30 1例 ,A组 1 4 2例 ,B组 1 59例。按Visick分级 ,A组Ⅰ级 97例 (68 3 % )、Ⅱ级 1 9例 (1 3 4% )、Ⅲ级 1 3例 (9 2 % )、Ⅳ级 1 3例 (9 2 % ) ;B组Ⅰ级 31例 (1 9 5 % )、Ⅱ级 2 8例 (1 7 6 % )、Ⅲ级 2 4例 (1 5 1 % )、Ⅳ级 76例 (47 8% ) ,2者比较 ,差异有非常显著性意义。 (Z =- 9 81 8,P <0 0 1 )。HP检测 ,A组阳性 1 30例 (91 5 % ) ;B组阳性 94例(59 1 % ) ,2者比较 ,差异有非常显著性意义。 (χ2 =41 438,P <0 0 1 )。 结论 对于穿孔性十二指肠溃疡 ,修补术联合PGV的远期疗效优于修补术联合三联疗法 ,尽管前者的HP阳性率远高于后者。HP感染只是十二指肠溃疡的发病?

Objective To study the long term curative effects of suture plus proximal gastric vagotomy(PGV) and suture plus triad therapy (omeprazole, amoxycillin and flagyl taken orally) for the treatment of duodenal ulcer with acute perforation. Methods Three hundred and twenty nine patients with duodenal ulcer and acute perforation were treated with 2 different methods, respectively. Method A was suture plus PGV (group A, 153 cases), and method B was suture plus triad therapy (group B, 176 cases). Follow up was made by means of correspondance, outpatient reexamination and cooperation with local hospitals in 5 to 8 years after operation. The contents of follow up included symptom aquisition(such as upper abdominal pain or distention, pyrosis, belch, acid regurgitation, vomiting, diarrhea and conditions of living or working), gastroscopy and Helicobacter pylori (HP) detection. The curative effects were evaluated by the Visick scale. Results Three hundred and one patients were followed up (group A 142 and group B 159). According to the Visick scale, 97 (68 3%), 19 (13 4%),13 (9 15%) and 13 (9 15%) patients in group A, and 31(19 5%), 28(17 6%), 24(15 1%) and 76 (47 8%) in group B were classified as VisickⅠ, Ⅱ, Ⅲ and Ⅳ respectively(Z=-9 818, P <0 01) . As for HP detection, there were 130(91 5%) patients in group A and 94(59 1%)in group B (χ 2=41 438, P <0 01). Conclusions The long term curative effects of suture plus PGV were superior to those of suture plus triad therapy for duodenal ulcer with acute perforation although HP positive rate was higher in group A than in group B. HP infection is one of the etiological factors of duodenal ulcer. The increased excitability of the vagus nerve remains to play an importment role in duodenal ulcer.