One hundred and ten patients with gastric ulcer underwent Roux-en-Y gastroentestinal reconstruction. The results of follow up from 1 to 14 years are as follows: Visick’s grade Ⅰ 89 cases (80.90%), grade Ⅱ 17 cases (15.45%), grade Ⅲ 3 cases (2.70%), and grade Ⅳ 1 case (0.90%). Two patients (1.80%) complicated with superficial marginal ulcer, and 7 cases (6.30%) with mild gastric retention. Neither alkaline reflux gastritis nor gastric remnant cancer was found in all this patients. The authors consider that Roux-en-Y gastroentestinal reconstruction could effectively prevent and treat alkaline gastritis, and there was no afferent loop complication in this series. The rate of recurrence and gastric retention was not higher than that of the Billroth operation.
Forty-two patients with duodenal ulcer underwent highly selective vagotomy and mucosal antrectomy (HSV+MA) and were followed up for 3 years. Two weeks, 1 year and 3 year after operation, serum gastrim level and gastric emptying capacity were tested. The results show that he postoperative levels of serum gastrin were lower than the preoperative ones, but wih no significant difference (Ｐ＞0.05). Only a few patients had delayed gastric emptying 2 weeks and 1year after operation,but it returned to normal in 3 years .The authors conclude that HSV+MA is a better operative treatment for duodenal ulcer since it can abolish the factors of postoperative ulcer recurence and perserve the functions of the antrum and the pylorus.
Objective To investigate the efficacy of pantoprazole and omeprazole as part of triple therapy in treatment of duodenal ulcer. Methods Seventy-eight patients with duodenal ulcer and HP-positive were randomized to two groups. A random number table was used to generate random sequence. The sequence was not concealed. No blinding was used. Thirty-nine patients received pantoprazole 40 mg + amoxicillin 1.0 g + clarithromycin 0.5 g (PAC group) and 39 patients received omeprazole 20 mg + amoxicillin 1.0 g + clarithromycin 0.5 g (OAC group), twice daily with duration of 7 days. The follow-up time was 4 to 6 weeks. Results At the end of the treatment, 38 patients completed the study, and 1 patient lost to follow-up in the PAC group; thirty-seven patients completed the study, two patients lost to followup in the OAC group. The results of intention-to-treat analysis and per-protocol analysis showed that the HP eradication rates were 87.2%/89.5% in the PAC group and 87.2%/91.9% in the OAC group (P＞0.05); the clinical improvement rates were 79.4%/81.6% in the PAC group and 82.0%/86.5% in the OAC group (P＞0.05). The side effect rates were 10.6% in the PAC group and 8.1% in the OAC group (P＞0.05). No significant difference was found between the two groups (P＞0.05). Conclusions The PAC group is therapeutically effective for eradication of HP and improves symptoms and has an equivalent effect to OAC group for patients with HP-positive duodenal ulcer. Both drugs are well tolerated.
Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.
Objective To explore the effect of laparoscopic highly selective vagotomy (Hill) on the treatment for acute perforating duodenal ulcer. Methods In 19 patients with acute perforating duodenal ulcers, laparoscopic repair of the perforation, laparoscopic freeing of the vagus, cutting off of posterior vagal trunk, and highly selective resection of anterior vagal trunk were performed. Results In all 19 cases the operation was successful. No patient was converted into open highly selective vagotomy. Ulcer symptoms of 17 patients disappeared after operation, and gastroscopy in follow up after 6 months showed that the ulcers had healed. The postoperative ulcer symptoms of 2 patients were markedly relieved and were easily controlled by medication. Conclusion The treatment of acute perforating duodenal ulcer by laparoscopic highly selective vagotomy (Hill) has the advantages of minor trauma, rapid postoperative recovery, and good results, it is a good procedure for the treatment of perforating duodenal ulcer.
目的 探讨预防胃大部切除术后碱性返流性胃炎的术式。方法 回顾性分析1998年6月至2008年12月期间我科收治的42例行胃大部切除术患者的临床资料，根据不同术式分为传统Billroth-Ⅱ（简称B-Ⅱ）式组（n=21）和改良B-Ⅱ式组（n=21），对2组患者术后胃肠引流液的量、剑突下持续烧灼痛、胆汁性呕吐、体重减轻以及肠胃液返流情况进行比较。结果 传统B-Ⅱ式组胃肠引流液量平均为（300±50） ml，而改良B-Ⅱ式组胃肠引流液量平均为（100±40） ml,2组间比较差异有统计学意义（P＜0.05）。传统B-Ⅱ式组剑突下持续烧灼痛12例，胆汁性呕吐8例，体重减轻1例； 而改良B-Ⅱ式组仅出现1例剑突下持续烧灼痛和1例体重减轻，未见胆汁性呕吐病例，2组间比较差异有统计学意义（P＜0.05）。传统B-Ⅱ式组发生轻度返流9例，重度返流12例; 改良B-Ⅱ式组仅2例发生轻度返流，1例重度返流，其余均未见返流，2组间比较差异有统计学意义（P＜0.05）。结论 与传统B-Ⅱ式相比，改良B-Ⅱ式的碱性返流性胃炎发生率明显降低，术后效果满意。
Objective To study the earlier and later clinic results of 64 chronic duodenal ulcer patients treated with high selective vagotomy and mucosal antrectomy (HSV+MA). Methods The clinic results of the patients and the changes of gastrin, motilin and somatostatin in the blood were prospectively investigated. Results Fifty nine (92.2%) patients after 3-6 months of follow-up and 26 (92.9%) patients after 5-8 years of follow-up achieved Visick grates Ⅰ-Ⅱ. No patients died. Gastric acid secretion and infection rate of helicobacter pylori in antral mucosa were significantly reduced after operation. No significant difference was showed in bile acids and total bacterial counts of gastric juice before and after operation. No ulcer recurrence was found by barium meal and endoscopy. There was no significant difference in serum gastrin and plasma motilin before and after operation. The level of somatostatin in the blood of patients after 5-8 years of follow-up was decreased. Conclusion HSV+MA is the better operative treatment for duodenal ulcer, since it can not only effectively and lastingly decrease acid secretion and rates of ulcer recurrence, but also preserve the function of the antrum and pylorus and keep the gastric milieu interne relatively stable.