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自1977年8月~1988年6月共作迷走神经切断术治疗十二指肠溃疡(DU)238例,根据临床及胃酸分泌试验的结果,选择作壁细胞迷走神经切断术(PCV)者100例,作选择性迷走神经切断加胃窦切除术(SV+V)者138例。部分病例随访1~10年,疗效属Visick Ⅰ、Ⅱ级者分别为96%和97%。PCV的溃疡复发率为1.96%,SV+A无复发者,术后远期副作用少,营养状况较好。随访资料表明:根据胃酸分泌的类型选择迷切方式,可以明显降低溃疡复发率,同时也强调精细熟练的手术操作对提高治疗效果的重要性。 相似文献
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自 1 970年Johnson首创壁细胞迷走神经切断术 (PCV)治疗十二指肠溃疡及并发症 ,在临床应用 30余年 ,其手术安全性高 ,手术并发症少等优点 ,已得到人们公认。 1 996年 9月至 2 0 0 1年 1 2月 ,我院对 2 0例十二指肠溃疡急性穿孔病人施行了壁细胞迷走神经切断术 ,疗效满意 ,现报道如下。1 临床资料1 996年 9月至 2 0 0 1年 1 2月 ,我院对 2 0例十二指肠溃疡急性穿孔病人施行了壁细胞迷走神经切断术 ,其中男性 1 4例 ,女性 6例 ,年龄 1 8~ 6 0岁 ,平均 4 2岁。穿孔到手术时间隔最短 6小时 ,最长 6 0小时 ,8小时以上者 1 6例 (占 80 % ) ,穿… 相似文献
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近年来,外科治疗十二指肠溃疡的发展,采用了胃壁细胞性迷走神经切断——即胃近端选择性迷走神经切断术或称高选迷走神经切断术。这种手术,仅切断胃近端2/3的神经;通过保留胃前、后壁的Latajet氏神经,保存了胃窦部及幽门的迷走神经支配;同样,通过保留了腹腔支和肝支保留了供给肠道和胆道的迷走神 相似文献
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自1977年以来采用迷走神经切断术治疗十二指肠溃疡238例,随机选择PCV15例及 SV+A13例,于手术前后进行胃体粘膜壁细胞的电镜观察、胃酸分泌试验及血清胃泌素测定,发现术后2~6周壁细胞的超微结构呈现分泌抑制的特征,同时胃酸降低;术后2~10年,PCV 病例壁细胞超微结构恢复到手术前的形态,但胃酸仍低,血清胃泌素增高;SV+A 的超微结构仍维持分泌抑制特征,胃酸及血清胃泌素乃持续低水平。证明迷切术后的胃酸降低是基于壁细胞超微结构的变化,为迷切治疗十二指肠溃疡提供了理论根据。 相似文献
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高度选择性迷走神经切断术(HSV)是治疗十二指肠溃疡的新方法,其手术原则是切断支配泌酸壁细胞团的迷走神经分枝,保留胃窦、幽门分枝,不附加引流。这个手术具有手术死亡率低、手术并发症少,近期疗效比较满意等优点,但溃疡复发率高,远期疗效尚要进一步观察。我科自1979年6月~1980年6月,试用HSV治疗十二指肠溃疡13例,其中12例经过5年随访,现报告如下: 一、一般资料本组男11例,女1例;手术时最大年龄65岁,最小23岁。4例并发疤痕性幽门梗阻,8例慢性十二指 相似文献
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目的:观察壁细胞迷走神经切断术加修补术,治疗幽门十二指肠溃疡穿孔的临床效果和实用价值。方法:纤维胃镜检查溃疡愈合情况,测定基础胃酸(BAO),五肽胃泌素刺激胃酸分泌量(PMAO),高峰酸(PAO)与择期十二指肠溃疡患者术前进行统计学分析。结果:壁细胞迷走神经切断术加修补术治疗的22例幽门、十二指肠溃疡穿孔患者术后无并发症,术后2~3周纤维胃镜检查溃疡完全愈合13例,部分愈合9例。经6月~5年随访,与择期十二指肠溃疡患者术前相比,BAO下降83%,PMAO下降61%,PAO下降56%,两组间差异均显著(P<0.01)。远期疗效属VisickⅠ级和Ⅱ级占86.4%,溃疡复发2例,经药物治疗后痊愈。结论:壁细胞迷走神经切断术加修补术破坏性小,安全性高,临床效果好,尤其适合基层医院采用。 相似文献
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钟飞彪 《浙江中西医结合杂志》2007,17(9):563-564
壁细胞迷走神经切断术是治疗十二指肠溃疡并发急性穿孔的传统手术方法,但手术后溃疡复发率较高。国内李世拥等报道了扩大的壁细胞迷走神经切断术(EPCV)。我院自1993年7月~2006年10月间收集并采取EPCV法治疗十二指肠并发急性穿孑L85例,现报道如下。 相似文献
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From Aug. 1977 to June 1988, vagotomy had been performed in 238 patients with duodenal ulcer (DU). According to the clinical signs and the result of gastric acid secretion test, (GAST) parietal cell vagotomy (PCV) and selective vagotomy plus antrectomy (SV+A) were performed in 100 and 138 cases respectively. The patients were followed up for 1 to 10 years. 96% and 97% of them belonged to Visick grade I and II respectively. The recurrence rate was 1.96% in PCV group, while no ulcer recurrence was seen in SV+A group, long-term side effect was rare and the nutritional status was quite good. The follow-up data showed that recurrence rate could be greatly reduced if the mode of vagotomy was selected according to results of GAST. 相似文献
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Ninety-five patients with perforation, hemorrhage or stenosis due to duodenal ulcer were treated by extended parietal cell vagotomy. Postoperative follow-up ranged from 3.5 to 10 years (mean 6 years) in 88 patients (92%) with acute perforation (60), hemorrhage (8) and stenosis (20). There was no operative mortality. Ulcer recurrence was 2.3%. Only one patient (5%) had restenosis and required reoperation. There was no recurrent hemorrhage and there were few long-term complications. According to the Visick classification, 67 patients (76%) belonged to grade I, 13 (14.7%) grade II, 4 (4.5%) grade III, and 4 (4.5%) grade IV. Extended parietal cell vagotomy proved to be safe with excellent results, low ulcer recurrence and few complications. Moreover, recurrent ulcers healed rapidly following medical therapy. The authors believe that extended parietal cell vagotomy should be the treatment of choice for acute perforation, hemorrhage or stenosis due to duodenal ulcer.
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Parietal cell vagotomy and selective vagotomy plus antrectomy in the treatment of duodenal ulcer. A follow-up of 10 years. 总被引:1,自引:0,他引:1
Two hundred and thirty-eight patients with duodenal ulcer were subjected to vagotomy. According to the clinical manifestations and the results of gastric acid secretion test, parietal cell vagotomy was done in 100 patients and selective vagotomy plus antrectomy in 138 patients. Follow-up after operation for 10 years showed that 96% and 97% of patients belonged to Visick Grade I and II respectively. The recurrence rate for parietal cell vagotomy was 1.96%, but no recurrence was seen in the group of selective vagotomy plus antrectomy. Long-term side-effects were rarely found in the patients. They had good nutritional states. The follow-up data showed that the recurrence rate could be greatly reduced if the modality of vagotomy was selected according to the type of gastric acid secretion test. The importance of surgeons experience and careful manipulation was emphasized.
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目的 :比较非手术与手术治疗穿孔性十二指肠溃疡的疗效。方法 :对我院 1995年 1月至 1999年 12月期间 ,所收治的 2 5 4例穿孔性十二指肠溃疡病人的临床资料进行回顾分析。结果 :非手术治 5 8例 ,1例出现腹腔脓肿 ,无一例再穿孔和死亡 ,3个月后溃疡愈合率为 92 .5 % ;手术治疗 186例 ,其中 10 2例行穿孔修补术 ,无一例出现腹腔脓肿 ,1例出现幽门梗阻需再行胃大切术 ,3个月后溃疡愈合 94 .1% ,与非手术治疗无明显差异 ,另外 84例行胃大部分切除术 ,出现残端漏 2例 ,腹腔脓肿 1例。结论 :急性十二指肠溃疡穿孔能自行闭合 ,以非手术治疗史合理和安全 ,通过使用抗生素、质子泵抑制剂或H2 受体阻止剂联合药物治疗 ,溃疡是可治愈的。不能自行闭合的急性穿孔 ,选择单纯修补可降低手术并发症 ,术后配合内科治疗也可达到溃疡治愈目的。慢性十二指肠溃疡穿孔 ,往往伴有溃疡周围疤痕多、胼胝状溃疡、幽门梗阻、病史长、症状严重反复发作等因素 ,即使穿孔超过 12h ,仍可以选择“溃疡确定性外科”治疗。 相似文献
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cagE在胃肠疾病患者中的分布及其临床意义 总被引:11,自引:2,他引:9
目的:研究cagE在幽门螺杆菌(Helicobacter pylori,Hp)感染的不同胃肠疾病患者听 分布及其与Hp感染相关疾病的关系。方法:合成cagEU1-cagEU2和cagE3-cagE4两组引物,应用聚合酶链反应(PCR)法扩增145株临床分离培养的Hp菌株cagE片段,结果:Hp临床菌株的cagEU1-cagEU2 PCR产物总检出率为75.9%(110/145),慢性胃炎、十二指肠溃疡、胃溃疡、复合溃疡中检出率分别为69.4%、85.4%、76.5%、75.0%,溃疡组略高于胃炎组,但差异无显著性(P>0.05)。cagE3-cagE4总检出率为42.1%(61/145),慢性胃炎、十二指肠溃疡、胃溃疡、复合溃疡中检出率分别为38.9%,47.9%,35.3%,50%,差异无显著性(P>0.05);cagE总检出率为79.3%(115/145)。结论:cagE在不同的消化道疾病患者感染的Hp中均有较高的检出率,在不同疾病中的分布无特异性,cagE尚不能单独作为与某种疾病相关的致病相关基因。 相似文献
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目的确定十二指肠溃疡穿孔单纯修补术+口服H2受体阻滞剂和(或)质子泵抑制剂或抗幽门螺杆菌(HP)等药物治疗的远期效果。方法对宣武医院1991年1月至2000年12月序贯收治的77例十二指肠溃疡穿孔单纯修补术+口服H2受体阻滞剂等药物的出院病人进行随访。结果随访到65例患者,术后溃疡症状复发率(VisickⅢ~Ⅳ)为15.4%(10/65)、再穿孔手术率为1.5%(1/65);40例复查内镜者复发7例(17.5%)。结论十二指肠溃疡穿孔修补术加H2受体阻滞剂或质子泵抑制剂及抗HP治疗的远期效果较满意。 相似文献
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本文测定49例慢性胃炎与20例溃疡病病人血中乙酰胆硷含量和胆硷酯酶活性,发现慢性胃炎病人有与溃疡病病人相似的消长变化,即在这两种疾病时,血中乙酰胆硷含量增高而胆硷酯酶活性明显降低。由于胆硷能神经刺激壁细胞和胃窦C细胞而促进胃酸分泌,故迷走神经机能亢进在十二指肠溃疡的发病中起重要作用。据本资料能否认为慢性胃炎病人也存在着副交感神经机能亢进呢?对此,值得积累更多资料,进一步探索。 相似文献
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Of 160 patients with pernicious anaemia, none had current duodenal ulceration, whereas in a random population of similar age and sex distribution some 5% would be expected to have a duodenal ulcer. Parietal-cell antibody was detected in serum from 8 of 169 men (4-7%) and from 2 to 31 women (6-4%) with duodenal ulceration. None of the 200 duodenal ulcer patients had antibody to intrinsic factor. The prevalence of these antibodies in duodenal ulcer patients was not significantly different from that in control subjects of similar age and sex distribution. The decreased prevalance of duodenal ulcer in pernicious anaemia patients implies that pernicious anaemia must be less prevalent in duodenal ulcer patients than in a random population; but it appears that this cannot be attributed to an absence of gastric autoimmunity in patients with duodenal ulcer. To resolve this disrepancy, we suggest that pernicious anaemia is determined not only by autoimmune reactions, but also by independent genetic and environmental factors which influence the state of the gastric mucosa. 相似文献