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Experimental Study and Clinical Application of Retrograde Liberated Highly Selective Vagotomy for Treatment of Duodenal ulcer
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- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF GASTROENTESTINAL SURGERY
- Issue:
- 1
- DOI:
- 10.3760/cma.j.issn.1671-0274.1999.01.007
- Key Word:
- 高选迷走神经切断术;逆行游离式;CO2激光;十二指肠溃疡
Abstract： 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.
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