高选迷切加胃窦粘膜切除术对胃电图的影响

为探讨高选迷切加胃窦粘膜切除术（ＨＳＶ＋ＭＡ）对胃运动功能的影响，作者对１２只犬及３０例十二指肠溃疡患者行ＨＳＶ＋ＭＡ前后胃窦运动功能及胃电图变化进行了对比研究。结果：在空腹状态下，犬手术前后胃窦压力无明显差别，但术后胃动作电位频率较术前明显减慢；肌注５肽胃泌素后，其手术前后的胃压力及动作电位频率也无明显差别。空腹状态下，十二指肠溃疡患者术后胃动作电位频率较术前明显降低，但胃电图值变化不大；餐后，其手术前后的胃电图值及频率较餐前明显升高，但术前、术后变化不大。表明ＨＳＶ＋ＭＡ对胃运动功能及胃电图影响不大。     

逆行游离式高选迷走神经切断治疗十二指肠溃疡的实验及临床应用研究

目的 介绍一种新高选迷走神经切断术(HSV)，即逆行游离式高选迷走神经切断术(RLHSV)，可方便而且彻底地毁损胃底体的迷走神经支配。方法 将28只狗随机分为RLHSV组(A)、传统HSV组(B)及对照组(C)后实施相应手术。然后进行胃酸分越试验及胃壁抻经辣根过氧化物酶(HRP)示踪观察。在证实狗RLHSV疗效后用于临床治疗60例十二指肠溃疡患。结果 A、B组术后狗胃酸分泌明显降低；胃体、底浆膜下注射HRP后，A、B组狗迷走神经背棱内未见HRP标记细胞、而C组则有标记细胞，注射于胃窦时三组均有标记细胞。胃壁组织化学及荧光染色观察显示A、B组狗的胃底、体的副变感神经完全受损而NE能神经正常存在。接受RLHSV术的患无重要并发症及手术死亡。随访6月-60月，属改良Visick Ⅰ、Ⅱ级54例，Ⅲ、Ⅳ级6例。术后2年至今复查胃镜40例，溃疡复发4例．其中2例无临床症状，另2例因症状重现而改行胃大部分切除治愈。结论 RLHSW术式具有手术操作方便，较易做到保留应保留的神经、切断应切断的神经分支，手术效果优良。     

高选迷切术式的应用

高选迷切术(HSV)在近些年来已成为国外治疗无严重并发症的十二指肠溃疡的定型手术。经过十余年的观察,已初步肯定了这种术式的优点,即手术死亡率极低,能完全消除溃疡症状并使胃酸及胃蛋白酶排量显著降低,保持胃的正常消化功能,极少发生倾倒综合征、腹泻及反流性胃炎等后遗症。在我国,虽然有些作者报道过少数病例,也有一些医院开展了此术式并大体肯定了上述优点。但由于长期以来胃大     

高选迷切加胃窦粘膜切除术治疗十二指肠溃疡远期疗效观察

高选迷切加胃窦粘膜切除术治疗十二指肠溃疡远期疗效观察第三军医大学第一附属医院外科（重庆，６３００３８）余佩武，杨顺兴，蔡志民文亚渊，王代科第三军医大学第三附属医院普外科高度选择性胃迷走神经切断术（ＨＳＶ）是治疗十二指肠溃疡的一种较好手术。其主要缺点是...     

高选择性迷走神经切断加胃窦粘膜切除术后胃窦运动功能的研究

高选择性迷走神经切断术（ＨＳＶ）加胃窦粘膜切除术（ＭＡ）同时去除了脑相和胃相的胃酸分泌，理论上是合理的。本实验结果提示：尽管横断了胃体，损毁了胃窦粘膜下神经丛，术后胃窦肌电活动频率有所减慢，但保留带有神经支配的浆肌层可发挥正常的生理功能，胃排空不受影响，无十二指肠返流过量，这为临床上进一步应用该术式提供了一定理论依据。     

高选迷走神经切断贲门周围血管离断术对胃功能的影响

目的高选迷走神经切断贲门周围血管离断术对胃功能的保护作用。方法127例门脉高压病人随机分为两组,一组行高选迷走神经切断贲门周围血管离断术为研究组,另一组行常规贲门周围血管离断术为对照组。术后以血清胃泌素、胃酸的变化及胃蠕动的恢复情况为观察指标。结果血清胃泌素研究组为(88·70±13·07)pg/ml,对照组为(75·17±11·43)pg/ml,两组对比P=0·046。基础胃酸排出量研究组为(2·36±1·01)mEq/ml,对照组为(1·03±0·88)mEq/ml,两组对比P=0·033。最大胃酸排出量研究组为(5·87±1·83)mEq/ml,对照组为(3·89±1·02)mEq/ml,两组对比P=0·026。胃肠功能恢复研究组平均为2·9d,对照组平均组为5·2d,P=0·01。结论高选迷走神经切断贲门周围血管离断术既治疗了原发病,又保护了胃功能,减少了并发症,提高了病人的生活质量。     

高选迷切加胃窦粘膜切除术的临床疗效观察

为评价高选迷切加胃窦粘膜切除术（HSV＋MA）治疗十二指肠溃疡的疗效，我们对45例行HSV＋MA者进行了术后1～7年临床疗效观察。临床疗效属VisickⅠ～Ⅱ级者占91．1％，Ⅲ级者8．9％。术后胃酸分泌较术前显著降低；术后胃液和血清胃泌素虽然较术前降低，但无显著差异；术后胃液胆酸浓度较术前升高，但无统计学意义。HSV＋MA可有效降低溃疡复发率，又可保留胃窦和幽门功能，是一种治疗十二指肠溃疡较理想的术式。     

高选择性迷走神经切断加胃窦粘膜切除术后胃窦运动功能的…

高选择性迷走神经切断术加胃窦粘膜切除术同时去除了脑相和胃相的胃酸分泌，理论上是合理的，本襁验结果提示：尽管横断了胃体，损毁了胃窦粘膜下神经丛，术后胃窦肌电活动频率有所减慢，但保留带有神经支配的浆肌层可发挥正常的生理功能，胃排空不受影响，无十二脂肠返流过量，这为临床上进一步应用该术式提供了一定理论依据。     

胃大部切除和高选迷切治疗十二指肠溃疡的临床效果比较

目的比较胃大部切除术和高选择性迷走神经切断术在治疗十二指肠溃疡的临床效果。方法将146例十二指肠溃疡患者随机分为2组。对照组应用胃大部切除术治疗,治疗组应用高选择性迷走神经切断术治疗。比较2组的治疗效果。结果治疗组的治愈率为95.89%,对照组为91.78%,组间比较,P>0.05,差异无统计学意义。治疗组不良反应发生率为6.85%,对照组为28.77%,组间比较,P<0.05,差异有统计学意义。治疗组术中平均出血量、手术时间、住院时间均明显少于对照组,P<0.01,差异有统计学意义。结论 2种手术方式临床疗效都很显著,但高选择性迷走神经切断术具有诸多优势,有推广价值。     

高选迷切加胃窦粘膜切除术治疗十二指肠溃疡

一种治疗十二指肠溃疡的较理想术式应该是手术病死率低,术后并发症和后遗症少,溃疡复发率低。目前用于治疗十二指肠溃疡的术式中,迷走神经干切断加胃窦切除术的溃疡复发率最低,平均<1%。然而其术后碱性返流性胃炎、倾倒综合征及腹泻发生率高达25%,手术病死率为2%。与之相比,单纯高选迷     

Clinical Results of Parietal Cell Vagotomy (Highly Selective Vagotomy) Two to Four Years After Operation

In Leeds and Copenhagen 271 patients were treated electively for duodenal ulcer by parietal cell vagotomy without drainage between 1969 and 1972 inclusive, with no operative deaths. 108 patients have been followed up 2–4 years since operation. Gastric stasis necessitating re-operation occurred in only 2 cases. Gastric ulcer developed in 2 cases, and in 3 cases recurrence of the duodenal ulcer was suspected but was unconfirmed at re-operation. Uncontrolled comparison with the results of partial gastrectomy and of vagotomy with drainage, as performed at these two centers, has shown that after parietal cell vagotomy without drainage there is a much lower incidence of dumping, diarrhea and bile vomiting, and, on overall assessment, a greater proportion of perfect or very good results.     

腹腔镜高选择性迷走神经切断术联合Nissen胃底折叠术:效果如何?——腹腔镜Nissen迷走神经切断术治疗胃食管返流

背景：Nissen胃底折叠术（Nissen fundoplication，NF）已不是治疗胃食管返流性疾病（gastroesophageal reflux disease，GERD）的唯一、有效的方法。对于能降低胃酸的手术方式来讲，如高选择性迷走神经切断术（highly selective vagotomy，HSV），也不仅仅是一种辅助治疗方法。对高选择性迷走神经切断术联合Nissen胃底折叠术（Nissen fundoplication with highly selective vagotomy，NFHSV）治疗GERD的作用目前尚无完整的评价。方法：2003年6月～2005年6月8例女性病人接受NFHSV，8例均有6个月GERD病史，经药物治疗症状无缓解，有餐前痛、消化性溃疡或严重的胃炎。平均随访时间12个月，术前、术后进行烧心严重程度评分测定（heart burn severity score，HSS）。结果：平均手术时间110min，无手术并发症。1例术后须用质子泵抑制剂，术后经戒烟5个月后停药。8例术后症状和烧心严重程度评分测定有明显改善。结论：NFHSV是有效的联合手术方式，尚需要进一步的研究证实这一联合术式的完全有效性和安全性。     

腹腔镜下高选择性迷走神经切断术(Hill术式)治疗急性十二指肠溃疡穿孔

目的探讨腹腔镜下高选择性胃迷走神经切断术(Hill术式)治疗急性穿孔性十二指肠溃疡及其效果。方法腹腔镜下行溃疡穿孔修补,游离胃迷走神经并行迷走神经后干切断和前干高选择性切断术治疗十二指肠溃疡急性穿孔患者19例。结果 19例患者均获得手术成功,无中转开腹手术者。术后17例溃疡症状消失,6个月后复查胃镜示溃疡已经愈合;2例患者术后溃疡症状明显减轻,药物治疗可控制。结论腹腔镜下高选择性胃迷走神经切断术治疗穿孔性十二指肠溃疡,具有创伤小、恢复快、效果好等优点,是治疗十二指肠溃疡穿孔的一种好方法。     

逆行游离式高选迷走神经切断治疗十二指肠溃疡的实验及临床应用研究

目的介绍一种新高选迷走神经切断术（ＨＳＶ），即逆行游离式高选迷走神经切断术（ＲＬＨＳＶ），可方便而且彻底地毁损胃底体的迷走神经支配。方法将２８只狗随机分为ＲＬＨＳＶ组（Ａ）、传统ＨＳＶ组（Ｂ）及对照组（Ｃ）后实施相应手术。然后进行胃酸分泌试验及胃壁神经辣根过氧化物酶（ＨＲＰ）示踪观察。在证实狗ＲＬＨＳＶ疗效后用于临床治疗６０例十二指肠溃疡患者。结果Ａ、Ｂ组术后狗胃酸分泌明显降低；胃体、底浆膜下注射ＨＲＰ后，Ａ、Ｂ组狗迷走神经背核内未见ＨＲＰ标记细胞，而Ｃ组则有标记细胞，注射于胃窦时三组均有标记细胞。胃壁组织化学及荧光染色观察显示Ａ、Ｂ组狗的胃底、体的副交感神经完全受损而ＮＥ能神经正常存在。接受ＲＬＨＳＶ术的患者无重要并发症及手术死亡。随访６月～６０月，属改良ＶｉｓｉｃｋⅠ、Ⅱ级者５４例，Ⅲ、Ⅳ级者６例。术后２年至今复查胃镜者４０例，溃疡复发４例，其中２例无临床症状，另２例因症状重现而改行胃大部分切除治愈。结论ＲＬＨＳＶ术式具有手术操作方便，较易做到保留应保留的神经，切断应切断的神经分支，手术效果优良     

腹腔镜下穿孔修补术联合高选择迷走神经切断术治疗十二指肠溃疡穿孔

目的探讨腹腔镜下穿孔修补术联合高选择迷走神经切断术治疗十二指肠溃疡穿孔的近期疗效。方法腹腔镜下修补溃疡穿孔,电刀游离迷走神经并进行高选择性切断。结果15例手术成功,无中转开腹手术,手术时间80-120 min,平均100 min;术中出血量150-300 ml,平均225 ml。15例术后随访12-36个月,平均29个月,13例术后1年复查胃镜溃疡消失,1例术后2年出现幽门梗阻保守治疗后好转出院,1例术后3年溃疡复发,经口服药物治疗易控制。结论腹腔镜下穿孔修补术联合高选择迷走神经切断术治疗十二指肠溃疡穿孔具有创伤小,恢复快,效果肯定等优点。     

Protection of the Gastroduodenal Mucosa from the Effects of Diclofenac Sodium: Role of Highly Selective Vagotomy and Misoprostol

p = 0.474 and p = 0.62, respectively). Misoprostol alone also did not offer significant protection to the gastric or the duodenal mucosa ( p = 0.08 and p = 0.65, respectively). The combination of HSV plus misoprostol protected the gastric mucosa (group V, p = 0.007) but not the duodenal mucosa (group V, p = 0.08). Hence HSV or misoprostol alone offers no protection to the GDM from the effects of DS. The combination of HSV and misoprostol offers significant protection only to gastric mucosa. Enhancement of the mucosal defense mechanisms combined with strong reduction of gastric acidity may offer adequate protection to gastric mucosa from the effects of nonsteroidal antiinflammatory drugs.     

Gastric Bypass Distal Roux-en-Y Jejunal Interposition with Selective Proximal Vagotomy and Posterior Truncal Vagotomy

Selective proximal vagotomy and posterior truncal vagotomy have been performed in 71 consecutive gastric bypass (GBP) patients from June 1991 to December 1992. Vagotomy was used to prevent or diminish the incidence of marginal ulcer in GBP patients. Anterior and posterior highly selective proximal vagotomy with circular-instrument stapled gastrojejunostomy in patients undergoing GBP distal Roux-en-Y with jejunal interposition had no marginal ulcer complications (minimal follow-up 18 months).     

An Interim Report on Parietal Cell Vagotomy Versus Selective Vagotomy and Antrectomy for Treatment of Duodenal Ulcer

This is an interim report of a prospective, randomized study involving 194 consecutive patients who underwent elective operation for treatment of duodenal ulcer. The results of parietal cell vagotomy without drainage (PCV) and selective vagotomy-antrectomy and Billroth I anastomosis (SV-A-B I) were compared. There was no mortality. Postoperatively patients were examined at two, six, 12 months and every 12 months thereafter. The two operations showed no statistical difference in the frequency of diarrhea. Dumping was less (p < .01) after PCV than after SV-A-B I. Weight loss was less (p < .01) after PCV than after SV-A-B I. There were no recurrent ulcers after SV-A-B I and five after PCV. In each instance but one the recurrent ulcer healed on withdrawal of an ulcerogenic drug. One patient required reoperation. Reoperations in the PCV group consisted of one for recurrent ulcer, one for gastric outlet obstruction and three for intestinal obstruction. The reoperations after SV-A-B I consisted of four for gastric outlet obstruction, three for intestinal obstruction, one for ruptured spleen and two for incisional hernia. PCV was technically feasible and practical to perform except in the occasional patient with severe pyloric stenosis. Obesity was never a deterrent. After PCV it is reasonable to assume that a recurrent ulcer rate in the range of 5-10% can be expected by surgeons who have been properly trained. This recurrence rate is higher than that after SV-A-B I but no higher than that encountered with TV-P. The recurrence rate is acceptable and is a fair exchange for the avoidance of dumping and weight loss that accompany SV-A-B I with significantly greater frequency and which on occasion can produce gastric crippling, although this did not occur in this study. All recurrent ulcers after PCV do not require reoperation but when operative treatment is required the patient has all the options that he had prior to PCV.