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Ulcus-Therapie pp 355–397Cite as

Therapeutisches Prinzip: Vagotomie

  • Conference paper

Part of the book series: Interdisziplinäre Gastroenterologie ((GASTROENTEROLOG))

Zusammenfassung

Die Anwendung der Vagotomie als therapeutisches Prinzip beim Ulcus geht von der Vorstellung aus, daß der N. Vagus in der Sekretionsphysiologie des normalen Magens und mehr noch beim peptischen Ulcus eine entscheidende Rolle spielt. Aus der langen Geschichte der Vagotomie sind hier vor allem zwei Namen zu nennen: Pavlov wies experimentell die Bedeutung des N. Vagus für die Sekretionsphysiologie des normalen Magens nach; Dragstedt, der in einer Vagus-Überfunktion die wesentliche Ursache der Hypersekretion des Ulcusleidens sah, führte, gestützt auf experimentelle und klinische Untersuchungsergebnisse, die Vagotomie in die chirurgische Behandlung des peptischen Ulcus ein [39]. Seitdem wird unter dem Begriff Vagotomie im klinischen Sprachgebrauch die Durchtrennung des N. Vagus oder seiner gastralen Äste verstanden, die dem Ziel einer Reduktion der Säuresekretionsleistung des Magens dient. Die Vagotomie kann in verschiedenen Varianten durchgeführt werden und erfordert dabei unterschiedliche Kombinationseingriffe (s.u.). Der Begriff Drainageoperation bezeichnet eine zusätzliche entleerungsverbes- sernde Maßnahme, die durch eine Schwächung der Pylorusfunktion als Pyloroplastik (P) oder zusätzliche Ableitung des Magens über eine Gastroenterostomie (GE) erfolgen kann. Eine mögliche Alternative könnte künftig die endoskopische oder chirurgische Pylorusdilatation (PD) darstellen (s. Kap. 29). Die Antrektomie (A) mit Wiederherstellung der Passage in Form einer Gastroduodenostomie (Typ BI) oder einer Gastrojeju- nostomie (Typ BII) ist ein weiterer häufig angewandter Kombinationseingriff.

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Authors
  1. J. R. Siewert
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  2. H. Bauer
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Editors and Affiliations

  1. Medizinische Klinik, Stadtspital Triemli, Birmensdorferstraße 497, CH-8063, Zürich, Switzerland

    André Louis Blum

  2. Klinikum rechts der Isar, der Technischen Universität München, Ismaninger Straße 22, D-8000, München 80, Germany

    Jörg Rüdiger Siewert (Direktor der Chirurgischen Klinik und Poliklinik) (Direktor der Chirurgischen Klinik und Poliklinik)

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Siewert, J.R., Bauer, H. (1982). Therapeutisches Prinzip: Vagotomie. In: Blum, A.L., Siewert, J.R. (eds) Ulcus-Therapie. Interdisziplinäre Gastroenterologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-68477-7_28

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