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Evaluation of Surgical Treatment for Chronic Gastric Ulcer T. Muto 1 , S. Koyama 1 , H. Matsuki 1 , M. Fukuda 1 , S. Narai 1 1Department of Surgery, Niigata University School of Medicine pp.813-822
Published Date 1978/6/25
DOI https://doi.org/10.11477/mf.1403107351
  • Abstract
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 A total of 1036 patients have been operated upon for chronic gastric and duodenal ulcer at the Niigata University Hospital in the past 17 years. Gastric ulcer was seen in 631 cases (60.9%), duodenal ulcer in 317 (30.5%), and coexisting gastroduodenal ulcer in 89 (8.6%).

 Selective surgery has been applied as a policy to each of the cases with gastric or duodenal ulcer in order to obtain suitable reduction of gastric acid serection and satisfactory preservation of gastric function along with no recurrent ulcer. Selective surgery has been performed in 631 consecutive cases with chronic ulceration of the stomach. Our standard operative procedures are (1) proximal gastrectomy with vagotomy, (2) segmental gastrectomy with or without vagotomy, (3) conventional partial gastrectomy (70% distal gastric resection), (4) antrectomy with or without vagotomy, and (5) the others.

 Overall operative mortality was 0.95%, although it was 0.3% in the recent 12 years. Recurrence was seen in one patient (recurrence rate=0.16%) who had undergone segmental gastrectomy with vagotomy. Incomplete vagotomy was the cause of recurrent ulcer in this case, which was cured by complete revagotomy. Postoperative disturbance (dumping syndrome, weight loss, diarrhea and anemia) were fewer in the patients who underwent segmental gastrectomy with selective proximal vagotomy than in those with proximal gastrectomy, conventional partial gastrectomy and antrectomy with or without selective gastric vagotomy.

 As to the postoperative alterations of serum vitamin B12, Schilling's test and intrinsic factor in gastric juice, there was no statistical difference between conventional partial gastrectomy, segmental gastrectomy with vagotomy and antrectomy with vagotomy. It is suggested that segmental gastrectomy be applied for high-located gastric ulcer, because disturbance of vitamin B12 absorption was seen in the patients who had subtotal gastrectomy.

 Postoperative level of serum calcium concentration showed more distinct decrease in the patients who had subtotal gastrectomy or conventional partial gastrectomy with Billroth-II type than in those with Billroth-Ⅰ. It is supposed that operations which bypass the duodenum and proximal portion of the jejunum decrease intestinal absorption of calcium.

 To get better results, several operative procedures with no gastric resection might be tried, although the small-extent gastric resection, with or without vagotomy, remains the most theoretically advantageous and clinically proven treatment of gastric ulcers.


Copyright © 1978, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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