消化性溃疡局部加胃窦切除及药物治疗的临床分析

目的 :分析消化性溃疡灶局部切除加胃窦切除并抗幽门螺杆菌 (HP)药物协同治疗的疗效。方法 :依胃横轴行溃疡灶按纵切横缝原则局部切除 ,范围超过边缘 1cm ,并作保留幽门的胃窦切除行胃十二指肠吻合 2 6例 ,术后均口服抗幽门螺杆菌药物 1周。结果 :本组病人术后随访 5年 ,2 4例自觉症状消失 ,体重增加 ;2例因肝炎后肝硬化行内科治疗。5年后定期胃镜复查均无溃疡复发 ,定期HP检查阴性。结论 :本方法创伤小 ,操作简单 ,能防止复发 ,且保留幽门 ,合乎人体生理 ,术后并发症少。     

溃疡局部加胃窦切除并抗幽门螺杆菌药物协同治疗患者的护理

目的探讨胃溃疡患者溃疡局部加胃寞切除并抗幽门螺杆菌(HP)药物协同治疗效果。方法依胃横轴行溃疡灶纵切横缝局部切除，并做保留幽门的胃窦切除行胃十二指肠吻合26例，术后均口服抗幽门螺杆菌药物21d。实行经管护士负责制，每位护士负责1～3例患者。从患者入院到出院的心理、生理、社会、家庭护理等．做到全身心的了解并落实治疗护理。结果本组患者术后随访5年．26例患者HP感染均为阴性，定期胃镜复查无渍疡复发。结论本方法创伤小．操作简单．防止复发．且保留幽门．符合人体生理，术后并发症少；而饮食、心理指导是保证手术成功的重要因素。     

溃疡局部加胃窦切除并抗幽门螺杆菌药物协同治疗患者的护理

目的探讨胃溃疡患者溃疡局部加胃窦切除并抗幽门螺杆菌(HP)药物协同治疗效果。方法依胃横轴行溃疡灶纵切横缝局部切除,并做保留幽门的胃窦切除行胃十二指肠吻合26例,术后均口服抗幽门螺杆菌药物21d。实行经管护士负责制,每位护士负责1~3例患者。从患者入院到出院的心理、生理、社会、家庭护理等,做到全身心的了解并落实治疗护理。结果本组患者术后随访5年,26例患者HP感染均为阴性,定期胃镜复查无溃疡复发。结论本方法创伤小,操作简单,防止复发,且保留幽门,符合人体生理,术后并发症少;而饮食、心理指导是保证手术成功的重要因素。     

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。     

消化性溃疡胃部分切除后幽门螺杆菌感染

幽门螺杆菌在消化性溃疡的发病中起重要作用．药物治疗有效，但易复发．尤其是不规律用药后。远端胃切除或迷走神经切断术后有时溃疡会复发。本探究部分胃切除后残留胃幽门螺杆菌感染与溃疡复发的关系。     

高选迷切加保留胃窦浆肌层的半胃切除对防止胆汁返流的价值

胃大部分切除由于切除了幽门可导致术后胆汁返流、倾倒现象等，而胆汁的返流是导致返流性胃炎、溃疡复发、癌前病变和死胃癌的主要原因为了防止这些并发症，我院于１９８８年设计了高迷切加保留胃窦浆肌胃窦浆肌层的半胃工发除治疗消化性溃病５０例，并与Ｂ－Ⅰ、Ⅱ式各１０例，ＨＳＶ２０例进行对比，结果显示，我们设计的术式可以防止胆返流。     

消化性溃疡胃部分切除后幽门螺杆菌感染

幽门螺杆菌在消化性溃疡的发病中起重要作用,药物治疗有效,但易复发,尤其是不规律用药后.远端胃切除或迷走神经切断术后有时溃疡会复发.本文探究部分胃切除后残留胃幽门螺杆菌感染与溃疡复发的关系.     

高选择性胃迷走神经切断术加保留幽门的胃窦粘膜切除术的应用

目的：观察高选择性胃迷走神经切断术加保留幽门的胃窦粘膜切除术（HSV PPMA）治疗十二指肠溃疡的远期疗效。方法：对1987年以来实施该手术后8-14年的34例患者进行了临床随访分析。结果：全组无手术死亡病例,临床属Visick分级Ⅰ-Ⅱ级者占94.1%。术后胃酸分泌及胃窦粘膜幽门螺杆菌感染率较术前有显著降低。血清胃泌素水平术后虽然较术前有所降低,但差异无显著性意义。术后胃液胆酸和细菌含量较术前相比无显著变化。胃排空均正常,X线钡餐和胃镜检查未发现溃疡复发。结论：HSV PPMA不仅能有效降低胃酸分泌,减少溃疡复发,而且能保存胃窦和幽门功能,防止术后胆汁反流和胃内细菌过度繁殖,是一种治疗十二指肠溃疡较理想的术式。     

十二指肠溃疡急性穿孔218例治疗分析

目的探讨十二指肠溃疡急性穿孔行单纯修补及术后药物治疗的效果。方法对我院2001年1月~2005年12月收治的十二指肠球部溃疡急性穿孔218例实施单纯修补术208例,术后给予抗溃疡药物及根除幽门螺杆菌(helicobacetr pylori,HP)治疗;保守治疗10例。结果本组近期效果良好。术后随访190例,随访半年~4年,溃疡复发13例,复发率为6%。失访28例。结论十二指肠溃疡急性穿孔行单纯修补术疗效确切。术后行正规抗溃疡及根除HP治疗能有效降低溃疡的复发率和并发症的发生率。     

消除幽门螺杆菌对十二指肠溃疡穿孔单纯修补术后的临床意义

目的 评估消除幽门螺杆菌(HP)对十二指肠溃疡穿孔单纯修补术后复发的影响和临床意义。方法 将123例十二指肠溃疡穿孔单纯修补术中的HP阳性110例随机分成抗HP组和非抗HP组各55例,进行随访及内镜检查,比较溃疡的初步愈合及1年后溃疡复发请况。结果 抗HP组和非抗HP组HP消除分别为53例及9例(P<0.001),溃疡早期完全愈合分别为52例及51例(P>0.5),1年后溃疡复发分别为2例及18例(P<0.01),有显著差异。结论 消除幽门螺杆菌可减少十二指肠溃疡穿孔单纯修补术后的溃疡复发,减少并发症出现。对于十二指肠溃疡穿孔的患者,除非有并发幽门梗阻、大出血或恶变等,否则一般可予单纯修补术,加以抗HP治疗,而不必予彻底性手术。     

Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial

OBJECTIVE: In this randomized trial, the authors sought to determine whether eradication of Helicobacter pylori could reduce the risk of ulcer recurrence after simple closure of perforated duodenal ulcer. BACKGROUND DATA: Immediate acid-reduction surgery has been strongly advocated for perforated duodenal ulcers because of the high incidence of ulcer relapse after simple patch repair. Although H. pylori eradication is now the standard treatment of uncomplicated and bleeding peptic ulcers, its role in perforation remains controversial. Recently a high prevalence of H. pylori infection has been reported in patients with perforations of duodenal ulcer. It is unclear whether eradication of the bacterium confers prolonged ulcer remission after simple repair and hence obviates the need for an immediate definitive operation. METHODS: Of 129 patients with perforated duodenal ulcers, 104 (81%) were shown to be infected by H. pylori. Ninety-nine H. pylori-positive patients were randomized to receive either a course of quadruple anti-helicobacter therapy or a 4-week course of omeprazole alone. Follow-up endoscopy was performed 8 weeks, 16 weeks (if the ulcer did not heal at 8 weeks), and 1 year after hospital discharge for surveillance of ulcer healing and determination of H. pylori status. The endpoints were initial ulcer healing and ulcer relapse rate after 1 year. RESULTS: Fifty-one patients were assigned to the anti-Helicobacter therapy and 48 to omeprazole alone. Nine patients did not undergo the first follow-up endoscopy. Of the 90 patients who did undergo follow-up endoscopy, 43 of the 44 patients in the anti-Helicobacter group and 8 of the 46 in the omeprazole alone group had H. pylori eradicated; initial ulcer healing rates were similar in the two groups (82% vs. 87%). After 1 year, ulcer relapse was significantly less common in patients treated with anti-Helicobacter therapy than in those who received omeprazole alone (4.8% vs. 38.1%). CONCLUSIONS: Eradication of H. pylori prevents ulcer recurrence in patients with H. pylori-associated perforated duodenal ulcers. Immediate acid-reduction surgery in the presence of generalized peritonitis is unnecessary.     

Long-term results of proximal gastric vagotomy

Proximal gastric vagotomy without drainage for duodenal ulcer was performed in 304 patients between 1969 and 1977. There was one operative death (0.3%) and two patients required secondary drainage (0.6%). Eleven patients died subsequently of unrelated causes. Follow-up 5 to 13 years after operation was conducted on 242 patients (80%). Of these, 141 were asymptomatic and 48 had only trivial symptoms, a success rate of 78%. Thirty-two patients had recurrent ulcer and 2 of them had Zollinger-Ellison syndrome. When these two were excluded, the recurrence rate was 12.4%. Two patients had duodenitis. Seven patients had unexplained pain and some of them may ultimately be shown to have recurrence. Appreciable esophageal reflux was seen in eight patients. Other symptoms, nearly all mild, were dumping in one, diarrhea in seven and bile reflux in six. Recurrent ulcer was treated by cimetidine initially in all 32 cases but ultimately by repeat vagotomy and antrectomy in 27, with no deaths and only one further recurrence (Zollinger-Ellison syndrome). After operative correction, the ultimate success rate (Visick grades I and II) was 90%.     

选择性迷走神经切断术加胃窦切除术治疗十二指肠溃疡远期疗效观察

目的：研究选择性迷走神经切断加胃窦切除术（SV＋A）治疗十二指肠溃疡远期疗效。方法：1977年11月－2001年11月采用SV＋A治疗193例十二指肠溃疡患者,其中顽固性溃疡28例,溃疡伴出血112例,溃疡伴幽门梗阻41例,胃十二指肠复合性溃疡12例。结果：SV＋A术后及术后随访基础胃酸分泌（BAO）、胰岛素刺激后胃酸分泌（IMAO）、五肽胃泌素刺激后胃酸分泌（PMAO）和血清胃泌素显著下降,壁细胞呈现分泌抑制的特征;术后1－10年和11－24年的随访,患者属于Visick I、Ⅱ级分别占95．60％和96．61％,Ⅲ级分别占（4．40％）和（3．39％）,无溃疡复发。结论：SV＋A降酸显著而持久,无溃疡复发。该术式是手术治疗十二指肠溃疡特别是溃疡并发症的有效方法。     

Reoperation for postsurgical peptic ulcer recurrence: appraisal of ten years' experience.

Between January 1, 1965 and December 31, 1974, 47 patients were treated at the University of Florida Affiliated Hospitals for peptic ulcer after a generally acceptable ulcer operation. Twenty-seven patients had had vagotomy and drainage, four patients had had vagotomy and antrectomy and 16 patients had had partial gastric resection. Forty-nine definitive operations were performed with a 4% operative mortality. Three patients (7%) had another ulcer recurrence following surgery. Left transthoracic vagotomy is the treatment of choice when recurrent ulceration follows subtotal gastrectomy or vagotomy and antrectomy. For ulceration following vagotomy and drainage, antrectomy, antrectomy is preferred. Synergism between hormonal and neural gastric stimulants causes a decreased parietal cell responsiveness to vagal stimulation after antrectomy. Exploration of the hiatus at the time of antrectomy increases the morbidity of the procedure. Should ulcers recur after antrectomy, vagotomy may be performed with a low morbidity through the transthoracic approach.     

Gastric ulcer after laparoscopic fundoplication for gastroesophageal reflux disease: significance of the eradication of Helicobacter pylori

The occurrence of gastric ulcers after laparoscopic fundoplication for gastroesophageal reflux disease is not uncommon. Between December 1994 and December 2004, we performed laparoscopic fundoplication in 180 patients, of whom 4 (2.2%) men developed a gastric ulcer during follow-up. The ulcers occurred predominantly in the upper part of the lesser curvature of the stomach, which is definitely different from the usual location of gastric peptic ulcers. All cases we experienced had Helicobacter pylori infection and eradication was attempted in all of them. Although eradication was not possible in 1 patient because of adverse effects to the drugs, successful eradication was obtained in the remaining 3 patients. After successful eradication, these 3 patients were placed under observation without medication and the ulcer has not recurred. The eradication of H. pylori may be an effective therapeutic means to prevent gastric ulcers recurrence after fundoplication.     

Recurrent peptic ulcer after surgery in Japan--a nationwide questionnaire survey of 57 institutions]

Patients with recurrent peptic ulcer undergoing surgery were reviewed at 57 institutions by the 18th meeting of the Japanese Research Society of Gastric Surgery. The factors involved in recurrence was analyzed in patients fulfilling the following criteria: the minimum follow-up period was over 5 years, the age was over 15 years, tetragastrin-stimulated acid secretion was measured before surgery, and the recurrence was confirmed by endoscopy or upper gastrointestinal radiography. In 632 patients, the recurrence rate of duodenal ulcer was significantly higher than that of gastric ulcer. However, the duodenal ulcer patients undergoing selective vagotomy and antrectomy did not develop recurrence. A significant difference in the recurrence rate was observed between selective vagotomy and antrectomy and the wide gastrectomy or selective proximal vagotomy. By analysis using the Cox proportional hazard model, the risk factors for recurrence of duodenal ulcer were the ulcer stage, the operative procedure, the location of the ulcer, and the age of the patient. Especially, recurrences in patients receiving selective proximal vagotomy depended on the location of the ulcer and the age, but the risk factors for patients undergoing wide gastrectomy were uncertain.     

Effect of Helicobacter pylori eradication on the ulcer recurrence rate after simple closure of perforated duodenal ulcer: retrospective and prospective randomized controlled studies

BACKGROUND: The possible advantage of eradication of Helicobacter pylori in patients with perforated duodenal ulcer is unknown. This study was planned to assess the prevalence of H. pylori after simple closure of a perforated duodenal ulcer and to study the effect of H. pylori eradication on ulcer persistence and recurrence. METHODS: Some 202 patients were followed prospectively for 2 years after simple closure of a perforated duodenal ulcer (prospective group). A second group of 60 patients was reviewed 5 years or more after perforation closure (retrospective group). The prevalence of H. pylori in patients with perforated duodenal ulcer was compared with that in controls. Patients in the prospective group were randomized to receive either ranitidine alone or quadruple therapy (ranitidine, colloidal bismuth subcitrate, metronidazole and tetracycline) after operation. The incidence of H. pylori infection after the two treatments and the association with residual or recurrent ulcer were studied. In the retrospective group long-term ulcer recurrence was correlated with H. pylori status. RESULTS: The prevalence of H. pylori in patients with perforated duodenal ulcer was not significantly different from that in controls. At every interval of follow-up in the prospective group and in the retrospective group the H. pylori infection rate was significantly higher in patients who had recurrent or residual ulcers. CONCLUSION: Eradication of H. pylori after simple closure of a perforated duodenal ulcer should reduce the incidence of residual and recurrent ulcers.     

Gastric outlet obstruction resulting from peptic ulcer disease requiring surgical intervention is infrequently associated with Helicobacter pylori infection

BACKGROUND: Gastric outlet obstruction (GOO) secondary to peptic ulcer disease requiring therapeutic intervention remains a common problem. The incidence of Helicobacter pylori infection in this cohort has not been well defined. Pneumatic dilatation (PD) has been proposed as first-line therapy before surgical intervention. If H pylori infection in patients with GOO is infrequent, PD may not offer permanent control without the need for longterm antacid therapy. STUDY DESIGN: The purpose of this study was to examine the incidence of H pylori infection and surgical outcomes in patients undergoing resection for GOO. The records of all patients having resection (vagotomy and antrectomy) for benign disease from 1993 to 1998 for GOO at the University of Tennessee affiliated hospitals were reviewed retrospectively. Smoking history, NSAID use, weight loss, previous ulcer treatment, previous treatment for H pylori, and previous attempts at PD were among the factors examined. H pylori infection was documented by Steiner stain from either preoperative biopsy or, in most patients, final surgical specimens. Surgical complications and patient satisfaction were ascertained from inpatient records, postoperative clinical notes, and, where possible, followup telephone surveys. RESULTS: Twenty-four patients underwent surgical resection during the study period. There were 16 men and 8 women, with a mean age of 61 years (range 40 to 87 years). Weight loss was documented in 58% and averaged 27 lb. Five of 24 patients had previous attempts at PD, 3 of whom were H pylori negative. All five had further weight loss after these failed attempts. Of the 24 patients reviewed, only 8 (33%) were H pylori positive. There were no procedure-related deaths. Longterm clinical followup was possible in 16 of 24 patients, and all but one demonstrated dramatic clinical improvement by Visick score. CONCLUSIONS: We conclude the following: 1) In this cohort, H pylori infection was present in a minority; 2) previous attempts at PD were unsuccessful, which may be related to the H pylori-negative status of the patients; 3) mortality related to the operation was zero; and 4) patient satisfaction was positive by the Visick scale. Patients with H pylori-negative GOO resulting from peptic ulcer disease should be strongly considered for an early, definitive, acid-reducing surgical procedure.     

Antrectomy for recurrent ulcer after parietal cell vagotomy

The results of antrectomy for recurrent ulcer after parietal cell vagotomy are reviewed. Eighteen patients underwent precise antrectomy between 6 months and 7 years after their primary operation. Fourteen patients were reconstructed with a gastroduodenostomy and 4 with a gastrojejunostomy. Eighteen patients were available for follow-up of between 18 months and 10 years. One patient (6.25 per cent) developed a recurrent ulcer 1 year after antrectomy. There was no operative mortality. Six patients (33 per cent) had minor complications in the immediate postoperative period, and one (5.5 per cent) had a major complication. According to Visick grading, 75 per cent had good or excellent results and 25 per cent poor results. Antrectomy following parietal cell vagotomy can be achieved with a low operative mortality, a low ulcer recurrence rate and a satisfactorily low incidence of post-gastrectomy problems.