Modified Goligher’s highly selective vagotomy (HSV) for 217 cases of duodenal ulcers is reported. In this series they were: duodenal ulcer (100 cases), combined gastric and duodenal ulcers (79 cases) and complicated perforating, bleeding or stenosed ulcers (38 cases). In the complicated duodenal ulcer, HSV was usually carried out with suturing bleeding point, perforated ulcer or with pyloroplasty. With a follow-up of 3~20 years, the recurrence rate werelt;2% and 85.7% of cases had excellent or good results as Visick classification. Considerations relevant to the HSV technic are deemed worthy of emphasis; complete resection of gastric branches of anterior and posterior vagal trunks and preservation of the first limb of the "Crow’s foot", extended dissection of the distal 5-7cm of the esophagus and division of the distal 8-10cm of the bundle of the gastroepiploic vessels in order to deprive the whole parietal cell mass of its vagal supply. In 4 patients, recurrence were easily controlled with remedies or operation for gastric retention by rational type. The authors suggest that the modified HSV plus mucusdeprived antrectomy be the rational surgical choice for duodenal ulcer.
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 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.
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.