陈道达 罗治义 芦晓明 刘建华 陈剑英 尤伟 同济医科大学协和医院普外科(武汉.430022) 中国胃肠外科杂志 1999 0 2 1


    关键词：高选迷走神经切断术；逆行游离式；CO2激光；十二指肠溃疡 期刊 zgwcwkzz 0 论著 fur -->


    

摘要 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。

Experimental Study and ClinicalApplication of Retrograde Liberated Hi g hly Selective Vagotomy for Treatment of Duodenalulcer

Daoda Chen, Zhi yi Luo, Xiaoming Lu,Jianhua Liu, Jiangying Chen,Wei You.General Surgery Departm ent, Union Hospital, TongjiMedical University, Wuhan,430022.

Abstract Objective We introducehere a new HSV procedure wh ich can destroy completely any existing variant vagal fibersinnervating three the p roximal stomach. Method 28 dogs were devided into3 groups, Retrograde liberated highly selective vagotomy (RLHSV) group (A)、classic HSVgroup (B) a nd the control group (C) . Gastric acid secretion function was tested andgastric parasympathetic and sym pathetic innervation were studied by retrogradely tracingthe HRP or by histoche mcal staining. Since it was verified that the modified procedurewas a more effective and easier HSV on animal model, we then applied it in clinic for treatment of duodenal ulcer on 60 patients. Result An apparent de crease ofacid secretion was found in operated dogs in both group A and B. After injection of HRPsubserous into the fundus and body, no HRP positive cell was found in the vagal dorsalnucleus in group A while were three found in group C. When HRP w as injected into the antrum, HRP stained cells were found in dorsal nucleus in a ll 3 groups. In the fundus andbody, parasympathetic nerve fibers were destroyed completely while norepipherinergic nervefibers were intact according to respec tfully the negative histochemical staining of AchEand the positive CA fluoresce nce in group A and B. Results Implied that our new procedureis definitely retional anatomically and physiologically. When the operation was applied inclinic,no severe complication or operation mortality occured. All pat ients were followedup for 6-60 months. They all had competen gastric empty fun ction. 54 patients wereappraised as Visick Ⅰ of Ⅱ.40 patients had taken gast ro scopies since 2 years afteroperation. Recurrant ulcer was detected in 4 patient s. Among them 2 patients had nosymptom. 2 patients who had symptoms were treate d again with partial gastectomy. Conclusion Comparing with th e classic (classic) HSV, we concluded that, our modified procedure wasmore eff ective and mo re convenient for performance. because it is easy to dissect allvagal branches that should be dissected and preserve all those that should be preserve.

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