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。     

腹腔镜高选择性迷走神经离断术治疗上消化道溃疡穿孔的临床研究

目的:评价腹腔镜穿孔修补术联合高选择性迷走神经离断术治疗胃十二指肠溃疡穿孔的疗效.方法:回顾分析2003年1月至2007年1月273例胃十二指肠溃疡穿孔患者的临床资料,其中胃穿孔149例,十二指肠穿孔124例.134例行腹腔镜穿孔修补加高选择性迷走神经切断术(研究组),139例行剖腹穿孔修补加高选择性迷走神经切断术(对...     

腹腔镜胃十二指肠溃疡急性穿孔修补术后治疗效果分析

目的:探讨腹腔镜辅助下胃十二指肠溃疡急性穿孔修补术及术后疗效及安全性。方法:回顾性分析手术治疗的胃十二指肠溃疡急性穿孔58例患者的临床资料,根据患者手术方法不同分为腹腔镜组(32例)和开腹组(26例),腹腔镜组在腹腔镜辅助下行穿孔修补术,开腹组行开腹穿孔修补术,比较两组患者手术时间、切口长度、术后下床活动时间、术后镇痛药物应用、术后胃肠道功能恢复、术后并发症发生率。结果:腹腔镜组手术时间、切口长度、术后下床活动时间、术后镇痛药物应用情况均优于开腹组(P0.05);腹腔镜组术后肛门排气时间短于开腹组(P0.05),术后胃肠道不良反应发生率低于开腹组(P0.05);腹腔镜组术后并发症的发生率明显低于开腹组(P0.05)。结论:腹腔镜辅助下胃十二指肠溃疡急性穿孔修补术具有手术时间短、创伤性小、术后胃肠道功能恢复良好等优点,可作为胃十二指肠溃疡急性穿孔的首选治疗方案。     

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。     

十二指肠溃疡急性穿孔不同手术方式疗效的比较研究

目的探讨十二指肠溃疡急性穿孔的不同外科手术方式的疗效。方法对120例十二指肠溃疡急性穿孔病人分别行开腹单纯穿孔修补术加用高选择性迷走神经切断术（Parietal Cell Vagotomy,以下简称PCV）、腹腔镜下穿孔修补加用PCV、开腹胃大部切除术。对其手术时间、住院时间、术后并发症、溃疡复发率进行比较观察。结果腹腔镜下十二指肠溃疡急性穿孔修补术＋PCV明显节省了手术时间、住院时间和减少了手术并发症,但与开腹胃大部切除术相比,溃疡复发率较高。结论腹腔镜下十二指肠溃疡急性穿孔修补加用PCV是较合理的选择,术后辅以制酸及抗Helicobacter pylori感染药物是必要的。开腹胃大部切除术已不再是治疗十二指肠溃疡急性穿孔的合理选择。     

老年人胃十二指肠溃疡穿孔的特征和治疗

目的：探讨老年人胃十二指肠溃疡穿孔的特征和治疗手段。方法：回顾性总结近20年来收治的58例60岁以上胃十二指肠溃疡穿孔患者的临床资料。结果：58例中56例行手术治疗，治愈46例，死亡12例。死于心肺功能衰竭5例，感染性休克4例，肾衰竭3例。结论：老年人胃十二指肠溃疡穿孔，宜争取早期手术；治疗方法以穿孔修补加高选迷走神经切断术，或修补加简化迷走神经切断术为较好选择。     

腹腔镜下胃、十二指肠溃疡穿孔修补术效果观察

目的观察开腹胃、十二指肠溃疡穿孔修补术与腹腔镜下胃、十二指肠溃疡穿孔修补术的治疗效果。方法将92例胃、十二指肠溃疡穿孔患者随机分为2组,每组46例。对照组实施开腹溃疡穿孔修补术,观察组实施腹腔镜下溃疡穿孔修补术,比较2组治疗效果。结果 2组患者均顺利完成手术,2组手术时间差异无统计学意义(P0.05)。观察组术中出血量、术后肠蠕动恢复时间、并发症发生率和住院时间均少于对照组组,差异有统计学意义(P0.05)。结论腹腔镜下胃十二指肠溃疡穿孔修补术创伤小、患者恢复快,术后并发症少,安全性高。     

腹腔镜胃十二指肠溃疡穿孔修补术效果观察

目的观察腹腔镜胃十二指肠溃疡穿孔修补术的治疗效果。方法选取2014-02—2015-02间收治的56例胃十二指肠溃疡穿孔患者,按照不同治疗方法分为2组,每组28例。开腹组实施开腹胃十二指肠溃疡穿孔修补术。腹腔镜组实施腹腔镜下胃十二指肠溃疡穿孔修补术。观察比较2组治疗效果。结果 2组患者均成功完成手术。腹腔镜组患者的手术时间、术后肠蠕动恢复时间均短于开腹组,术后并发症发生率低于开腹组,2组差异均有统计学意义(P005)。结论腹腔镜胃十二指肠溃疡穿孔修补术治疗创伤小,术后并发症低,术后恢复快。     

腹腔镜胃十二肠溃疡穿孔修补辅助H2受体拮抗剂治疗急性胃十二指肠溃疡穿孔

目的:总结腹腔镜下胃十二指肠溃疡穿孔修补术的临床经验。方法:回顾分析采用腹腔镜行胃十二指肠溃疡穿孔修补术的33例临床资料。结果:除1例十二指肠溃疡穿孔时间较长中转手术外,29例十二指肠球部穿孔和3例胃穿孔患者腹腔镜手术均获得成功,无并发症发生;术后辅助H2受体拮抗剂治疗,胃镜复查无复发。结论:腹腔镜修补并H2受体阻断剂口服治疗胃十二指肠溃疡急性穿孔的效果是肯定的,值得临床应用推广。     

逆行游离高选择性胃迷走神经切断术治疗十二指肠溃疡

目的：探讨逆行游离高选择性胃迷走神经切断术治疗十二指肠溃疡的可行性和有效性,评估该术式的远期效果,为临床治疗提出新思路。方法：应用逆行游离高选择性胃迷走神经切断术治疗十二指肠溃疡主其工发穿孔、出血和狭窄患者70例,其溃疡穿孔61例,出血6例,狭窄3。结果：65例患者获得访,总的溃复发率为7.69%,再出血率为0。随访30-120个月,属改良VisickⅠ级56例占86.2%,Ⅱ级4例占6.1%,Ⅲ级2例占3.0%,Ⅳ级3例占4.6%,Ⅰ、Ⅱ级共占92.3%。结论：逆行游离高选择性胃迷走神经切断术治疗十二指肠溃疡及其并发症,具有缩短手术时间、简化手术操作、患者远期预后好等优点,可作为治疗十二指肠溃疡合并症的一种有效的方法。     

Surgical treatment of perforative gastroduodenal ulcers in elderly and senile patients

The work is based on experiences with surgical treatment of 206 elderly and senile patients with perforating gastroduodenal ulcers. In 67.5% of cases the perforations took place in duodenal ulcers, in 16%--in the pyloric canal. The gastric body and antral portion ulcers were perforative more rarely--9.8% and 4.8% respectively. Perforations of the cardial and retrobulbar ulcers were found in 1.9% and 1% respectively. At early terms after operation 67 patients (33.5%) died. After suturing the perforative opening 38 out of 98 patients died (38.8%), after dissection and suturing the ulcers died 7 out of 19 patients, after Oppel-Polikarpov operation died 7 out of 11, after resection of the stomach died 4 out of 6, after truncal vagotomy with pyloroplasty died 11 out of 72 patients (15.3%). The main cause of lethal outcomes is thought to be complications of the coexistent diseases, totally responsible for 46.2% of deaths. Truncal vagotomy with a dissection of the ulcer and pyloroplasty performed in 60-70 year old patients gave the least indices of lethality and early postoperative complications, so the indications to radical organ-saving operations in patients of this age must be wider. This method of treatment for perforative ulcers in patients of 71-80 years of age should be used with restrictions due to not bad long-term results of suturing the ulcers (good and excellent results took place in 53.8% of cases). In patients older than 80 radical operations are not indicated. In such cases the ulcer should be better dissected and sutured, the posterior wall of the organ being examined for a "mirror" ulcer.     

Endoscopic management of peptic ulcer disease.

OBJECTIVE: This article reviews the authors' experience with endoscopic management of duodenal ulcer and ulcers occurring after a previous drainage procedure. SUMMARY BACKGROUND DATA: Patients with complications of duodenal ulcer and ulcers occurring after a previous drainage procedure still require surgical management. Virtually all operations for duodenal ulcer include some form of vagotomy. American surgeons in academic centers prefer highly selective vagotomy in suitable candidates. Video-directed laparoscopic and thoracoscopic operations have been done for all complications of duodenal ulcer except for acute hemorrhage. METHODS: The authors have performed laparoscopic operation on eight patients with intractable chronic duodenal ulcer, seven patients with gastroesophageal reflux disease combined with duodenal ulcer, one patient with chronic duodenal ulcer and gastric outlet obstruction, and one patient with acute perforation. Operations performed included omentopexy, anterior seromyotomy plus post truncal vagotomy, and highly selective vagotomy. Seven patients had a simultaneous Nissen fundoplication; and the patient with obstruction underwent concomitant pyloroplasty and vagotomy. Six patients with intestinal ulcers occurring after a previous drainage procedure were treated with thoracoscopic vagotomy. Techniques used are shown. RESULTS: There has been one recurrent ulcer in the laparoscopic group after anterior seromyotomy plus posterior truncal vagotomy. The patient treated by omentopexy for duodenal perforation recovered gastrointestinal function promptly with no further difficulty, but eventually died of primary medical disease. Patients undergoing thoracoscopic vagotomy have all become asymptomatic. Postoperative hospital stay after highly selective vagotomy, anterior seromyotomy plus posterior truncal vagotomy, or thoracoscopic vagotomy was 1-5 days. CONCLUSIONS: Laparoscopic management of duodenal ulcers is feasible. Larger numbers of patients with longer follow-up are essential. Ulcers occurring after a drainage procedure deserve thoracoscopic vagotomy.     

Six-year results of a prospective, randomized trial of selective proximal vagotomy with and without pyloroplasty in the treatment of duodenal, pyloric, and prepyloric ulcers.

In a consecutive series of patients with uncomplicated prepyloric, pyloric, or duodenal ulcer, 39 patients were randomly allocated to selective proximal vagotomy with pyloroplasty, and 40 patients to selective proximal vagotomy alone with no operative mortality. Before surgery, all patients had undergone H2-receptor antagonist treatment. No patient was lost for follow-up. At an average follow-up of 6 years, recurrent ulcer was recorded in 15% and 20%, respectively, after selective proximal vagotomy with and without pyloroplasty. Three of 14 recurrent ulcers were asymptomatic. Epigastric pain with or without ulcer was significantly less common after selective proximal vagotomy with (13%) than without pyloroplasty (40%). Mild diarrhea or mild dumping was recorded in a few patients. The overall results were very good or good (Visick I or II) in 77% and 55% (significant difference) after vagotomy with and without pyloroplasty, respectively, and in 82% and 58%, if asymptomatic ulcers were graded as Visick I or II results. Of the 27 patients with Visick III or IV results, three patients needed no treatment (asymptomatic ulcers), and 10 patients had no symptoms during medical treatment. Two patients with vagotomy and pyloroplasty and nine with vagotomy alone were reoperated. There were no deaths, and the results were graded as Visick I or II in 10 patients and as Visick III in one patient. The authors conclude that selective proximal vagotomy with pyloroplasty is superior to vagotomy alone for the treatment of prepyloric-pyloric and duodenal ulcer. Recurrent ulcer after vagotomy has a benign course and responds well to ranitidine treatment.     

Recurrent peptic ulceration after highly selective vagotomy: long-term outcome

A prospective assessment was made of the outcome 4 years after diagnosis of recurrence in a group of 27 patients with documented ulceration after highly selective vagotomy (16 symptomatic recurrence and 11 asymptomatic). In the 16 patients with a previous symptomatic recurrence, eight of the 11 patients with duodenal ulcer underwent a further endoscopy at 4 years and one active ulcer was found. Five patients with previous symptomatic gastric ulcer recurrence have all undergone further surgery. In the 11 patients who originally had an asymptomatic ulcer recurrence (five gastric, six duodenal) no patient has undergone further surgery, although two patients with a recurrent gastric ulcer and two with a recurrent duodenal ulcer subsequently developed symptoms from their ulcer and required H2 receptor blocker therapy. Eight of the 11 originally asymptomatic patients underwent further endoscopy at 4 years and two further duodenal ulcers were found. After highly selective vagotomy, asymptomatic ulcer recurrence occurs frequently and 40 per cent of these patients may develop symptoms.     

The choice of the surgical treatment method in gastric and duodenal peptic ulcer]

Operations were carried out on 966 patients for gastric ulcer (GU) and duodenal ulcer (DU); the ages of 78% of them ranged from 31 to 50 years. 241 patients underwent operation for GU. Stenosing ulcer was found in 21.4%, penetrating ulcer in 37.3%, bleeding ulcer in 29%, perforating ulcer in 8.3%, and ulcer-tumor in 3.4% of patients. Resection of the stomach after Billroth I was conducted in 32.2%, pyloric preserving resection in 43.1%, Spasokukotski?-Finsterer operation in 5.7%, and selective proximal vagotomy with excision of the ulcer in 19% of patients. DU was found in 725 patients. The ulcer was stenosing in 42.2%, penetrating in 37%, bleeding in 14.7%, and perforating in 6.1% of patients. The following operative interventions were performed: gastric resection after Spasokukotski?-Finsterer, selective proximal vagotomy and pyloroplasty, selective proximal vagotomy, Billroth I operation, excision of the ulcer and selective proximal vagotomy, stitching of the vessels. The long-term results were good in 94.5% of patients.     

Surgical treatment of patients with perforated peptic ulcers

Results of surgical treatment of 782 patients with perforated gastric and duodenal ulcers are analyzed. Gastric ulcers of I type were diagnosed at 86 (10.9%) patients, prepyloric and pyloric ulcers - at 441 (56.4%), duodenal ulcers - at 255 (32.6%) patients. Perforation was combined with bleeding and stenosis at 24 (3.1%). Palliative operations have been performed at 172 (22.0%) patients, stem vagotomy with ulcer excision and pyloroplasty - at 58 (7.4%), various types of stomach resection - at 54 (6.9%), proximal gastric vagotomy with excision of gastric, pyloric or duodenal ulcer - at 77 (9.8%), proximal gastric vagotomy with excision or suturing of ulcer and pyloro- or duodenoplasty - at 421 (53.8%) patients. The rate of postoperative complications after proximal gastric vagotomy was 3.6%, after stomach resection - 18.2% (p<0.01). Early postoperative complications after vagotomy with ulcer excision and pyloroplasty were diagnosed at 8.3%, after stomach resection - at 18.2% patients (p<0.01). The quality of patients life was higher after organ-saving operations. Proximal gastric vagotomy with excision of ulcer and pyloro- or duodenoplasty should be regarded as operation of choice at perforated duodenal ulcers.     

Postoperative results of distal partial gastrectomy, selective vagotomy plus antrectomy, and selective proximal vagotomy for duodenal ulcers

We investigated the postoperative results of distal partial gastrectomy, selective vagotomy plus antrectomy, and selective proximal vagotomy, to evaluate their effectiveness in the treatment of duodenal ulcers. The operative mortality of selective vagotomy plus antrectomy and selective proximal vagotomy seemed to be lower when compared to distal partial gastrectomy, although each procedure showed a sufficiently low mortality. The acid reduction rate was significantly lower after selective proximal vagotomy than after the other procedures (p less than 0.01). However, the rate of ulcer recurrence following selective proximal vagotomy tended to be higher compared with the other procedures. All three procedures showed good results according to Visick's grading and postoperative symptoms occurred in about 50 per cent of all patients, no matter what the procedure. The regaining of physical ability was significantly greater following selective proximal vagotomy than following distal partial gastrectomy (p less than 0.05) and the capacity to work was also better after vagotomy, particularly selective vagotomy plus antrectomy (p less than 0.05). Thus, although distal partial gastrectomy and selective vagotomy plus antrectomy proved superior regarding the low ulcer recurrence rate and acid reduction, while selective proximal vagotomy proved superior for improving the quality of life, on the whole, the three operations promise almost equivalent results.     

Minimal resections in surgical treatment of perforative duodenal ulcers

289 patients were operated on the reason of perforative duodenal ulcer. Omental tamponade of the ulcer after Oppel-Policarpov was performed in 260 (90%) cases; traditional ulcer closure with omental support - in 13 (4,5%); excision of the ulcer?- in 4 (1,4%); truncal vagotomy and pyloroplasty - in 9 (3,1%) and gastric resection was performed in 3 (1%) patients. After 277 operations "of minimal volume" major complications were registered in 21 (7,6%) patients with lethal outcomes in 9 cases. All patients received adequate antiulcer drug treatment. Follow-up results, obtained in 153 patients, demonstrated good results of the operation and nonrecurrent course in 133 (86,9%) cases. The omental tamponade of the ulcer after Oppel-Policarpov proved to be the method of choice in treatment of the perforative duodenal ulcer. Early beginning of antiulcer conservative treatment after the operation provide excellent results and stable recovery.     

Parietal cell vagotomy for duodenal and pyloric ulcers: I. Clinical factors leading to failure of the operation

In a prospective study, 170 consecutive unselected patients with duodenal (n = 115) or pyloric (n = 55) ulcers underwent elective parietal cell vagotomy, with an additional drainage procedure in patients with stenosis. The patients were classified in two consecutive groups and were followed up for 3 to 7 years after operation, in 132 cases for more than 5 years. The follow-up was complete. Patients with symptoms suggestive of ulcer for more than 3 days, independent of roentgenographic or endoscopic findings, were classified as having symptoms of recurrent ulcer and were specially analyzed.There was no mortality; splenic injuries occurred in 5 cases (3 percent), dumping symptoms in 4 percent after parietal cell vagotomy but in 34 percent after vagotomy plus drainage. Diarrhea occurred in 3 percent of the patients after parietal cell vagotomy and in 20 percent after vagotomy plus drainage.Fifty-five patients had clinical recurrences, significantly more patients with pyloric ulcer (46 percent) than with duodenal ulcer (28 percent). In 27 patients, the symptoms responded well to conservative therapy. In the other 28 patients the symptoms were severe, and 14 underwent reoperation for proven recurrent ulcers. The difference in the recurrence rates for duodenal and pyloric ulcer was found only in patients who did not undergo a drainage procedure, while pyloric ulcer patients with stenosis and a drainage operation were comparable in this respect to duodenal ulcer patients with and without drainage.A decrease in the rate of recurrence was achieved between the earlier and later parts of the series, even considering the difference in length of follow-up. The decrease is considered to reflect mainly our increased experience with the method. The results in patients in the later part of the series, followed up for more than 5 years, were a 22 percent incidence of recurrent ulcer symptoms and an 8 percent incidence of proven recurrent ulcers in those with duodenal ulcer, and a 28 percent incidence of recurrent ulcer symptoms and a 22 percent incidence of proven recurrent ulcers in those with pyloric ulcer.The overall results in patients followed up to more than 5 years, according to a modified Visick scale which incorporates differences in the severity of recurrent ulcer symptoms and the results after reoperation, were satisfactory in 89 percent of the patients with duodenal ulcer and in 73 percent of those with pyloric ulcer.     

Hemipylorectomy with transverse pyloroplasty and vagotomy in perforating and bleeding ulcers of the pyloric canal

Hemipylorectomy with transverse pyloroplasty and vagotomy was made in 922 patients with perforating and bleeding ulcers of pyloric canal. 510 of them had perforation of ulcer, 412--ulcer bleeding. In all the cases ulcer was excised together with anterior semicircle of the pylorus, the defect was sutured transversely. Hemipylorectomy with transverse pyloroplasty was combined with (anterior selective proximal serous-muscular and posterior trunkal) vagotomy. Postoperative lethality in perforation of ulcer was 4.8%, in bleeding--8.2%. From 1 year to 10 years after operation good functional results were achieved in the majority of the patients. This variant of organsaving operation is optimal in complicated ulcers of pyloric canal.