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目的 探索治疗十二指肠溃疡穿孔简捷、有效的手术方法。方法 自 1993～ 1996年对壁细胞迷走神经切断术进行改良 ,手术不游离食道下段、不显露迷走神经、不分离切断胃大弯近侧网膜及胃底血管 ,对胃底浆肌层仅作部分切开 ,以此法治疗十二指肠溃疡穿孔 45例。结果 应用此法 (改良壁细胞迷走神经切断术 )使手术难度降低 ,手术时间缩短 ,适应范围扩大。 45例平均随访34 6个月 ,VisickⅠ、Ⅱ 41例 (41/ 45 ,91% )。基础胃酸排量 (basalacidoutput,BAO) (4 1± 2 1)mmol/h ,最高胃酸分泌量 (maximalacidoutput,MAO) (16± 6 )mmol/h ,溃疡复发 3例 (3/ 35 ,9% )。结论 改良壁细胞迷走神经切断术是治疗十二指肠溃疡穿孔的合理方法 ,对穿孔时间较长及老龄病人尤为适宜。
Objective To explore a simple and effective surgical method for perforation of duodenal ulcer. Methods The parietal cell vagotomy was improved from 1993 to 1996. The operation did not break away from the lower esophagus and did not reveal the vagus nerve. The proximal retinal membrane and the gastric fundus were not severed and the gastric myofibroblasts were only partially cut Open, in this way to treat 45 cases of duodenal ulcer perforation. Results The application of this method (modified parietal cell vagotomy) makes surgery less difficult, shorter operative time, to adapt to the expansion. 45 cases were followed up for an average of 34 months and 41 cases (41/45, 91%) of Visick Ⅰ and Ⅱ. The basal gastric acid output (BAO) (4 1 ± 2 1) mmol / h, maximalacid output (MAO) (16 ± 6) mmol / h and ulcer recurrence in 3 patients . Conclusion Modified parietal cell vagotomy is a reasonable method for the treatment of perforation of duodenal ulcer and is particularly suitable for patients with long perforation and elderly patients.