Læknablaðið - 15.04.1985, Blaðsíða 13

LÆKNABLAÐIÐ
85
blönduðum hópi sjúklinga eru 6.8% í Visick-
flokki III og IV. í kanadísku uppgjöri (13) á
sári í skeifugörn, er tíðni endurmyndunar sára
6,5%. Ef við miðum útreikninga okkar við þá
sem hafa sár í skeifugörn eingöngu, falla
6.7% sjúklinga undir Visick-flokk III, þ.e.
ófullnægjandi árangur aðgerðar.
Af þessum 35 sjúklingum hafði enginn
fengið einkenni um hraða tæmingu maga
(dumping) eftir aðgerð. Saga um niðurgang
kom fram hjá sjö, en hjá fimm þeirra var hann
sjaldgæft fyrirbæri og þarfnaðist ekki
meðferðar. Þessi lága tíðni fylgikvilla er einn
helsti kostur þessarar aðgerðar (2, 4, 10, 13).
Hnitrof á skreyjutaug hefur í för með sér
hærri tíðni endurmyndaðra sára en aðrar
aðgerðir við ætisári í maga og skeifugörn.
Hinsvegar eru flestir sammála um, að þessi
endurmynduðu sár séu yfirleitt léttbærari, en
þau sár er voru fyrir og svari betur lyfja-
meðferð.
Fyrst flutl sem erindi á aðalfundi Skurðlæknafélags íslands í
Borgarnesi 27. apríl 1984, af öðrum höfundi (MO) þessarar
greinar.
SUMMARY
Highly Selective Vagotomy in 35 patients at St. Joseph’s
Hospital, Reykjavík 1977-1983.
A review of thirty five cases of highly selective
vagotomy is presented. During the years 1977-1983,
fifteen females and twenty males were treated for peptic
ulcer with highly selective vagotomy. Twenty-five of the
patients had duodenal and/or pyloric ulcer, five patients
had gastric ulcer, one had both duodenal and gastric
ulcer. Four of the patients had chronic gastro-duodenitis.
Prior efforts of medical treatment had been made for all
patients, without satisfactory results.
Early in 1984 all thirty-five patients were contacted.
They had all been under observation after surgery for a
period of five months to six years, the mean observation
time being 2,8 years. All patients were in good health.
None had been admitted to hospital due to peptic ulcer.
Two patients had symptoms of peptic ulcer, but milder
than before operation and were easily controlled by
medication. Nine patients had symptoms of the previous
disease, but not influencing their life-style. No case of
dumping was found. By the modified Visick grading
system, 33 are in group I and II, but two in group III. A
recurrence rate of 5.7 percent compares favourably with
current literature.
HEIMILDIR
1) Hadfield J, Hobsley M. Highly selective vagotomy,
history and nomenclature. Curr Surg Pract 1976:
100: 80-8.
2) Herslag A, Argov S. Parietal Cell vagotomy. II. The
First Decade - Clinical considerations. Curr Surg
1983; 40: 93-104.
3) Arnþórsson G. »Highly Selective Vagotomy
(HSV)». Læknaneminn 1975; 28: 62-81.
4) Stabile BE, Passaro E. Duodenal Ulcer: A Diseasein
Evolution. Curr Prob Surg 1984: 4-79.
5) Herslav A, Argov S. Parietal Cell Vagotomy. I. The
First Decade - Physiologic Considerations. Curr
Surg 1983; 40: 4-12.
6) Elder JB, Ganguli PC, Koffman CC et al. Randomi-
zed Trial of Elective, Highly Selective or Truncal
Vagotomy in Chronic Duodenal Ulceration. Can J
Surg 1983; 26: 119-22.
7) Koo J, Lam SK, Chan P et al. Proximal Gastric
Vagotomy with Drainage and Truncal Vagotomy
with Antrectomy for Chronic Duodenal Ulcer. Ann
Surg 1983: 197: 265-71.
8) Selking Ö, Krause U, Nilsson F, Thorén L. Parietal
Cell Vagotomy and Truncal vagotomy as Treatment
of Duodenal Ulcer. Acta Chir Scand 1981; 147: 561-
7.
9) Fraser AG, Brunt PW, Matheson NA. A comparison
of highly selective vagotomy with truncal vagotomy
and pyloroplasty-one surgeon’s result after 5 years.
Br j Surg 1983; 70: 485-8.
10) Gleysteen JJ, Condon RE, Tapper EJ. Prospective
trialofproximal gastric vagotomy. Surgery 1983; 94:
15-20.
11) Knight CD, Van Heerden JA, Kelly KA. Proximal
Gastric Vagotomy. Ann Surg 1983; 197: 22-6.
12) Schulze S, Poulsen E, Christiansen J. Parietalcelle-
vagotomi for ulcus duodeni. Ugeskr Læger 1982;
144:710-13.
13) Macmillan JI, Dover MR, White D. Proximal
Gastric Vagotomy: a 7-year Review. Can J Surg
1983; 26: 220-2.
14) Gonzalez EM, Arnau BN, Dupont TC, Andollo JF.
Proximal Gastric Vagotomy. A Prospective Study of
829 Patients with Four-year Follow-up. Acta Chir
Scand 1983; 149: 69-70.
15) Jordan PH. Treatment of GAstric Ulcer by Parietal
Cell Vagotomy and Excision of the Ulcer. Arch Surg
1981; 116: 1320-3.
16) Reid DA, Duthie HL, Bransom CJ, Johnson AG.
Late follow-up of highly selective vagotomy with
excision of the ulcer compared with Billroth I
gastrectomy for treatment of benign gastric tulcer.
Br J Surg 1982; 69: 605-7.
17) Dunn DC, Thomas WEG, Hunter JO. Highly
selective vagotomy and pyloric dilatation for duode-
nal ulcer with stenosis. Br J Surg 1981; 68: 194-6.
18) Rossi RL, Braasch JW, Cady B, Sedgwick CE.
Parietal Cell Vagotomy for Intractable and Obstruc-
ting Duodenal Ulcer. Am J Surg 1981; 141; 482-6.