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題 名 | 以高選擇迷走神經切斷術治療十二指腸潰瘍之臨床經驗 |
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作 者 | 張景年; 商東福; 陳楷模; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 25:3 民81.05-06 |
頁 次 | 頁1157-1165 |
分類號 | 416.243 |
關鍵詞 | 高選擇迷走神經切斷術; 十二指腸潰瘍; |
語 文 | 中文(Chinese) |
中文摘要 | 十二指腸潰瘍之外科治療方法極多,其效果好壞亦莫衷一是,在過去四年半內省立新竹醫院對179位潰瘍病人施以手術,其中39位病人,我們以擴大高選擇迷走神經切斷術治療,我們以這些病人追踪,4人失去聯絡,病人中20位係穿孔,10位係出血,阻塞3位,難治的疼痛2位,其手術併發症為脾臟被膜裂傷(未做脾臟切除術)及術後出血各為1位(2.6%),無手術死亡率,術後罹病為腹脹6位(17.1%),嘔膽水5位(14.3%),腹瀉、吞嚥困難各4位(11.4%),便秘、傾倒症候群,易飢餓各佔一位(2.9%)。如以Visick grading作長期追踪之依據有94.3%為Visick I或II,表示絕大多數病人生活品質良好。我們的結論是這是一種對胃腸道生理影響最少,可高度改善生活品質的手術,其復發率可以相當低,而最重要的條件是要由有經驗的醫師執行,而且迷走神經要切得夠完全,總之這是一種值得推廣的手術。 |
英文摘要 | There are many ways of the surgical management of duodenal ulcer, but the results are controversial. In the past four years and six months, there were 179 ulcer patients undergoing operations at our hospital. Among them, 39 were treated with highly selective vagotomy, four of them were lost to follow-up. In the remammg patients, 20 patients treated with highly selective vagotomy were caused by perforation, and 10 by bleeding. Obstruction and pain were noted in three and two, respectively. The complications were noted as the splenic capsule avulsion (no splenectomy was necessary), and the post-operative bleeding in one each. There was no lesser curvature necrosis, or operative mortality. The post-operative complications were abdominal distention in six (17.1%), acid regurgitation in five (14.3%), diarrhea and dysphagia in four (11.4%). Constipation, dumping syndrome and easy hunger were noted in one in each category (4.3%). All these complications were easy to treat and all were returned to normal within one month. We used Visick grading as criteria for evaluating the operative results and have found that 94.3% (33 patieats) were in Visick grades I and II, which meant that most of the patients have been enjoying good life quality post-operatively. We concluded that the highly selective vagotomy is a good procedure to improve the life quality with minimal side effect. The recurrence rate could be low if the procedure is performed by experienced doctors and vagotomy is complete. |
本系統中英文摘要資訊取自各篇刊載內容。