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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，手术效果优良
Objective To introduce a new high-grade vagotomy (HSV), retrograde free high-powered vagotomy (RLHSV), which can easily and completely destroy vagal innervation of gastric fundus. Methods 28 dogs were randomly divided into RLHSV group (A), conventional HSV group (B) and control group (C). Then gastric acid secretion test and gastric wall horseradish peroxidase (HRP) tracer observation. After validating the efficacy of RLHSV in dogs, 60 patients with duodenal ulcer were treated clinically. Results The gastric acid secretion of dogs in group A and group B was significantly decreased. HRP-labeled cells were not observed in the vagus nerve of dogs in group A and group B after HRP was injected into the subserosus, while in group C, labeled cells were injected into the stomach All three groups had labeled cells. Gastric wall histochemistry and fluorescence staining showed that the parasympathetic nerves of the stomach and body of dogs in group A and group B were completely damaged while NE could function normally. Patients receiving RLHSV had no major complications and died of surgery. Follow-up from June to 60 months, 54 cases were modified Visick Ⅰ and Ⅱ, and 6 cases were Ⅲ and Ⅳ. Forty cases were examined by gastroscopy 2 years after operation, 4 cases were ulcer recurrence, of which 2 cases had no clinical symptoms and the other 2 cases were cured by resection of most of the stomach due to the recurrence of symptoms. Conclusion The RLHSV technique has the advantages of convenient operation, easy to retain the nerves to be retained, cut off the nerve branches should be cut off, the operation effect is excellent