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目的评价扩大壁细胞迷走神经切断术(EPCV)治疗十二指肠溃疡并发急性穿孔的远期效果。方法对1979—2004年我院239例十二指肠溃疡并发急性穿孔患者施行EPCV术后胃酸分泌功能、并发症发生率、溃疡复发率和VISICK分级等进行了分析。结果239例中随访到203例,随访率为84·9%。全组无手术死亡。术中脾损伤4例(1·7%),粘连性肠梗阻6例(2·5%),突发性腹泻3例(1·3%),进食后上腹胀满18例(7·5%)。术后远期并发症有:偶尔上腹痛、返酸16例(7·8%),粘连性肠梗阻4例(1·9%),十二指肠球变型39例(18·2%),慢性胃炎21例(10·3%),复发性溃疡6例(2·9%)。术后3~10年基础酸分泌量、最大酸分泌量、高峰酸分泌量分别下降为84·7%、60·0%、58·0%(t=36·584),P<0.01。结论EPCV术式降酸显著,能有效地降低术后溃疡复发率,做为治疗十二指肠溃疡并发急性穿孔是一种安全、有效的术式。
Objective To evaluate the long-term effect of expanding parietal cell vagotomy (EPCV) for acute perforation of duodenal ulcer. Methods The gastric acid secretion function, incidence of complications, recurrence rate of ulcer and VISICK classification of 239 cases of duodenal ulcer complicated with acute perforation in our hospital from 1979 to 2004 were analyzed. Results Of the 239 patients, 203 were followed up, with a follow-up rate of 84.9%. The whole group died without surgery. Intraoperative spleen injury in 4 cases (1.7%), adhesive intestinal obstruction in 6 cases (2.5%), sudden diarrhea in 3 cases (1.3%), eating up abdominal fullness in 18 cases (7.5 %). Postoperative long-term complications included occasional upper abdominal pain with acid reflux in 16 cases (7.8%), adhesive intestinal obstruction in 4 cases (1.9%), duodenal bulb variant in 39 cases (18.2%), , Chronic gastritis in 21 cases (10.3%) and recurrent ulcer in 6 cases (2.9%). The basal acid secretion, the maximal acid secretion and the peak acid secretion decreased to 84.7%, 60.0% and 58.0% (t = 36.584), P <0.01 after 3 to 10 years. Conclusions The EPCV procedure has a significant reduction of acidity and can effectively reduce the recurrence rate of postoperative ulcer. It is a safe and effective procedure for the treatment of duodenal ulcer complicated with acute perforation.