保留幽门的胃窦黏膜切除加高选择性迷走神经切断术后临床疗效观察

目的观察保留幽门的胃窦黏膜切除加高选择性迷走神经切断术(高选迷切术)治疗十二指肠溃疡的疗效。方法对实施该术式的48例患者术后3～6个月及8～12年临床随访结果进行分析总结。结果全组无死亡病例。术后3～6个月及8～12年VisickⅠ～Ⅱ级分别为93.8％和95.3％。术后胃酸及胃窦黏膜幽门螺杆菌感染率与术前比较明显降低(P＜0.05)，术后胃液胆酸及血清胃泌素无明显改变，X线钡餐及胃镜检查未发现溃疡复发。结论保留幽门的胃窦黏膜切除加高选迷切术不仅能保留胃窦、幽门功能，使胃内环境保护相对稳定，而且能有效、持久地降低胃酸分泌，减少溃疡复发和术后并发症的发生，是治疗十二指肠溃疡较理想的术式。

Clinical investigation after pylorus-preserved mucosal antrectomy plus high selective vagotomy

Objective To study the short- and long-term clinical results of 48 chronic duodenal ulcer patients treated with pylorus-preserved mucosal antrectomy plus high selective vagotomy ( PPMA HSV) . Methods Clinical follow-up results of the patients from 3-6 months and 8 - 12 years were summarized. Results Forty-five (93. 8% ) patients of 3 -6 months follow-up and 20/21(95. 3%) patients of 8 - 12 years follow-up after operation achieved Visick grades I - II. No patient died. Gastric acid secretion and infection rate of helicobacter pylon in antral mucosa were significantly reduced after operation. No significant difference was found in bile acids of gastric juice and in the level of serum gastric after operation. No ulcer recurrence was found by barium meal and endoscopy. Conclusion PPMA HSV is a better operative treatment for duodenal ulcer, which can decrease the acid secretion, the rate of ulcer recurrence and postoperative complications effectively and lastingly.