摘要
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。
Objective We introduce here a new HSV procedure
which can destroy completely any existing variant vagal fibers innervating three the proximal
stomach. Method 28 dogs were devided into 3 groups, Retrograde liberated highly selective
vagotomy (RLHSV) group (A)、classic HSV group (B) and the control group (C). Gastric acid
secretion function was tested and gastric parasympathetic and sympathetic innervation were
studied by retrogradely tracing the HRP or by histochemcal staining. Since it was verified that
the modified procedure was a more effective and easier HSV on animal model, we then applied
it in clinic for treatment of duodenal ulcer on 60 patients. Result An apparent decrease of acid
secretion was found in operated dogs in both group A and B. After injection of HRP subserous
into the fundus and body, no HRP positive cell was found in the vagal dorsal nucleus in group A
while were three found in group C. When HRP was injected into the antrum, HRP stained cells
were found in dorsal nucleus in all 3 groups. In the fundus and body, parasympathetic nerve
fibers were destroyed completely while norepipherinergic nerve fibers were intact according to
respectfully the negative histochemical staining of AchE and the positive CA fluorescence in
group A and B. Results Implied that our new procedure is definitely retional anatomically and
physiologically. When the operation was applied in clinic,no severe complication or operation
mortality occured. All patients were followed up for 6-60 months. They all had competen gastric
empty function. 54 patients were appraised as Visick Ⅰ of Ⅱ.40 patients had taken
gastroscopies since 2 years after operation. Recurrant ulcer was detected in 4 patients. Among
them 2 patients had no symptom. 2 patients who had symptoms were treated again with partial
gastectomy. Conclusion Comparing with the classic (classic) HSV, we concluded that, our
modified procedure was more effective and more convenient for performance. because it is
easy to dissect all vagal branches that should be dissected and preserve all those that should
be preserve.
