Abstract
This is a report of 152 patients with gastric ulcer treated by ulcerectomy, vagotomy, and drainage. In the series, 123 patients were operated on electively and 29 were operated on acutely for bleeding, with operative mortality rates of 1.3% and 6.9%, respectively. The operative mortality rate for the whole series was 2.6%. Of 144 patients followed up, 94 were cured and 25 were improved. The remaining 25 patients were reoperated on, 20 for recurrent ulcer, 2 for early postoperative gastric retention, 2 for dumping and reflux gastritis, and 1 for stenosing ulcer in the esophagus. In the group of 119 successfully treated patients, moderate side effects were observed, including diarrhea in 5.2% and dumping in 8.6%. In 26 patients, the mean reduction of histamine-stimulated or pentagastrin-stimulated acid output was 72.2% when the response to insulin stimulation was 0, 45.1% when the response to insulin was between 0 and 2 mEq acid per hour, and 12.4% when the response was higher. The frequency of positive insulin tests postoperatively was 77.8% among patients with recurrent ulcer, 40% among improved patients, and 10.8% among cured patients. Of 4 patients with ulcer recurrence and negative insulin tests, 3 had gastric retention and 1 hypergastrinemia.
Résumé
Cent cinquante-deux malades atteints d’ulcère gastrique ont été traités par excision de l’ulcère, vagotomie et drainage: 123 opérations non urgentes, avec une mortalité de 1.3%, et 29 urgences pour hémorragie aiguë, avec 6.9% de décès. La mortalité globale est de 2.6%. Sur 144 malades suivis, 94 sont guéris et 25 améliorés. Les 25 autres patients ont été réopérés, 20 pour récidive ulcéreuse, 2 pour rétention gastrique postopératoire précoce, 2 pour dumping ou gastrite par reflux, 1 pour ulcère sténosant de l’oesophage. Chez les 119 malades traités avec succès, les séquelles postopératoires sont d’importance modérée: 5.2% de diarrhée et 8.6% de dumping. La réduction du débit acide après histamine ou pentagastrine, mesurée chez 26 malades, est de 72.2% lorsque la réponse à la stimulation insulinique est nulle; elle est de 45.1% lorsque la réponse insulinique est de 0–2 mEq d’acide/heure et de 12.4% dans les cas où la riposte insulinique est plus élevée. Le test à l’insuline après l’opération est positif dans 77.8% des cas lorsqu’il y a récidive ulcéreuse, dans 40% chez les malades améliorés et dans 10.8% chez les patients guéris. Sur 4 malades ayant une récidive ulcéreuse avec test à l’insuline négatif, 3 avaient une rétention gastrique et 1 une hypergastrinémie.
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Johnson, J.A., Giercksky, KE. Gastric ulcer treated with ulcerectomy, vagotomy, and drainage. World J. Surg. 4, 463–467 (1980). https://doi.org/10.1007/BF02393175
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DOI: https://doi.org/10.1007/BF02393175