選択的近位迷走神経切離術兼幽門形成予術の長期予後の検討 ： 広範囲胃切除術と比較して

Abstract

The long-term clinical results of selective proximal vagotomy with pyloroplasty (SPV+D) were determined in comparison with those of distal gastrectomy (B-I) among 303 patients who underwent surgical treatment at our institution between 1972 and 1991. SPV+D and B-I were performed for duodenal ulcer (n=27, 15), gastric ulcer (n=6, 18) and gastroduodenal ulcers (n=3, 3). Postoperative follow-up observation ranged from 8 to 18 years after SPV+D and from 3 to 17 years after B-I. The cumulative ulcer recurrence rate after SPV+D was 19.4%, significantly higher than after B-I (5.6%). While 95.2% of patients returned to work within the first 6 months after SPV+D, only 80% did so after B-I. No significant differences were found in the percentage who regained their preoperative weight or recovery of food intake after SPV+D and B-I. Nor was there any significant difference between SPV+D and B-I in incidence of heartburn or heavy feeling of epigastrium. The dumping syndrome occurred in 20% of patients after B-I, but in none of the patients after SPV+D. Based on Visick Grading, 79.3% of patients operated by SPV+D have a satisfactory outcome (i. e. Visick grades Ⅰ+Ⅱ), whereas 90.0% of those operated by B-I have a satisfactory outcome. This difference is not statistically significant. In conclusion, we recommend SPV+D to patients with duodenal ulcer and adequate criteria in order to prevent the postgastrectomy syndrome and to satisfy the various needs of patients who desire to undergo operative procedumes.