舌形瓣溃疡贴壁缝合治疗难治性十二指肠后壁溃疡合并大出血

目的探讨难以切除的十二指肠后壁溃疡合并大出血时的手术方式。方法回顾性分析47例难以切除的十二指肠后壁溃疡合并大出血时的临床资料。其中35例为十二指肠球部溃疡，12例为球后溃疡。手术方式：12例球后溃疡行Billroth-Ⅱ式，35例球部溃疡行Bancroft术式，溃疡肠腔内旷置，十二指肠前壁部分做成舌形瓣与溃疡贴壁缝合。结果1例十二指肠漏，所有病例顺利康复。随访9个月～5年无再出血。结论该术式相对简单，创伤少，止血确切，并发症少，再出血率低，较为理想。     

难以切除的十二指肠球后溃疡大出血的手术方法

十二指肠球后溃疡 ,虽然少见 ,但易并发出血。十二指肠球后溃疡向后壁穿透时 ,溃疡的底部实际上是胰腺组织 ,底部的血管被侵蚀后可致大量出血。一般对于难以切除的十二指肠球部后壁穿透性溃疡采用Ｂａｎｃｒｏｆｔ手术方法 ,不强调切除溃疡 ,以免发生严重的并发症。但当溃疡合并大出血时 ,Ｂａｎｃｒｏｆｔ手术的止血效果不理想 ,术后继发出血者较多见。为防止再出血 ,应直接处理溃疡底部并关闭十二指肠残端。常用的手术方法有以下几种。一、残端后壁覆盖溃疡法 (Ｇｒａｈａｍ手术 )1.手术步骤 :①手术基本步骤同胃大部切除术 ,但在处理溃疡…     

胃十二指肠溃疡出血胃切除术后大出血的外科治疗

目的 总结胃十二指肠溃疡出血行胃大部切除术后大出血再手术治疗的经验。方法 对我院1980年至2002年间收治的26例胃切除术后大出血再手术患者的临床资料进行回顾分析。结果 本组有6例术前行急诊胃镜检查，11例行术中胃镜检查，2例采用超选择性动脉造影。11例球部旷置溃疡出血或球后溃疡出血者，采取旷置溃疡切除或十二指肠球部及降部纵行切开、直视下缝合出血点，同时阻断十二指肠周围血管手术；13例吻合口出血者，局部缝扎止血、切除原吻合口，再作毕Ⅱ式重建或行空肠胃Roux-en-Y吻合；还有2例行再次胃切除手术。治愈24例(92．3％)；死亡2例(7．7%)，均为术后再出血者。结论 术前采用超选择性血管造影及术中胃镜检查，有利于明确出血部位及原因；选择恰当的手术方式对防止术后再出血非常重要。     

十二指肠球部后壁溃疡并发出血治疗术式的选择

为探讨十二指肠球部后壁溃疡并发出血时手术方式的选择. 回顾性分析不同术式治疗35例十二指肠球部后壁溃疡并发出血的临床资料,术式包括Nissen法14例,Brancroft-Plenk法8例,Graham法13例.观察各种术式的止血效果,近期并发症发生率等;比较3种术式的优缺点.结果示Nissen法术后无再出血病例,术后发生近期并发症2例(2/14),手术时间(180±60)min;Graham法术后无再出血病例,术后发生近期并发症3例(3/13),手术时间(190±70)min;Brancroft-Plenk法术后再出血2例(2/8),术后发生近期并发症3例(3/8), 手术时间(175±50)min.提示对十二指肠球部后壁溃疡并发出血的治疗,采用 Nissen法和Graham法止血效果较好,并发症少,但手术操作复杂;Brancroft-Plenk法止血效果较差,并发症较严重,不宜采用.     

低位十二指肠穿透溃疡大出血治疗体会

目的：总结２５例低位十二指肠穿透溃疡大出血的手术经验。方法：降部前壁穿透溃疡大出血２例，行溃疡切除，Ｔ字型缝合法；球部后壁１５例，行改良Ｎｉｓｓｅｎ氏法；降部前壁并球部后壁５例，联合用上述两法；球部后壁穿孔２例，行Ｌａｈｅｙ氏法；球部前壁严重疤痕并后壁巨大穿透溃疡大出血１例，行十二指肠残端－空肠Ｒｏｕｘ－Ｙ吻合法。结果：均手术治愈，无严重并发症。结论：术中彻底探查胃十二指肠，选择适当术式，开放式处理残端，可提高治愈率，减少并发症     

低位十二指肠穿透溃疡大出血治疗体会(附25例报告)

目的:总结25例低位十二指肠穿透溃疡大出血的手术经验.方法:降部前壁穿透溃疡大出血2例,行溃疡切除,T字型缝合法;球部后壁15例,行改良Nissen氏法;降部前壁并球部后壁5例,联合用上述两法;球部后壁穿孔2例,行Lahey氏法;球部前壁严重疤痕并后壁巨大穿透溃疡大出血1例,行十二指肠残端-空肠Roux-Y吻合法.结果:均手术治愈,无严重并发症.结论:术中彻底探查胃十二指肠,选择适当术式,开放式处理残端,可提高治愈率,减少并发症.     

溃疡腔内隔绝术治疗难治性十二指肠溃疡出血22例

目的探究溃疡腔内隔绝术治疗难以切除的十二指肠溃疡合并大出血的可行性。方法采用描述性病例系列研究方法, 回顾性分析2018—2022年期间邵阳市中心医院实施的22例溃疡腔内隔绝术(14例为十二指肠球部后壁溃疡出血, 8例为球降交界处溃疡出血)患者的临床资料, 其中男性15例, 中位年龄63.5(42.0～87.0)岁;首次大出血7例, 曾有上消化道出血和(或)大出血者15例。溃疡腔内隔绝术是直视下缝扎止血后, 将溃疡隔绝于功能肠腔及腹腔之外的一种手术方式, 其关键步骤是:切开胃窦及十二指肠球部前壁后, 直视下缝扎溃疡止血, 在溃疡远端0.5～1.0 cm处于十二指肠腔外进针, 完全黏膜下潜行围绕肠管一圈后肠腔外打结, 电刀毁损溃疡周围肠黏膜后, 于溃疡近端闭合十二指肠残端, 将溃疡与肠腔及腹腔隔绝。观察患者术后恢复情况和并发症情况。结果 22例患者均顺利完成手术, 手术时间(116.4±18.6)min, 术中出血量(42.7±13.6)ml;其中16例一并行逆行性十二指肠造口术+营养性空肠造口术。21例患者术后均恢复良好, 顺利康复出院;仅1例87岁高龄患者术后死于多器官功能衰竭。术后...     

十二指肠穿透性溃疡大出血的手术治疗体会

目的 总结二十指肠穿透性溃疡大出血的手术治疗体会。方法 球部后壁9例,行改良Nissen法;球后和球部后壁穿孔5例,行Lahey法;降部前壁穿透性溃疡大出血2例,行溃疡切除,T字型缝合法。结果 均手术治愈,无十二指肠残端漏等严重并发症。结论 术中彻底探查胃十二指肠,明确诊断,选择适当术式开放处理十二指肠残端,可提高治愈率,减少并发症和医源性损伤。     

十二指肠球部溃疡合并Dieulafoy大出血3例报告

上消化道大出血病因中Ｄｉｅｕｌａｆｏｙ病较为罕见 ,我院收治 3例十二指肠球部溃疡出血合并Ｄｉｅｕｌａｆｏｙ大出血病人 ,均经手术证实。现将诊治体会报告如下。1　病历介绍例 1 男性 ,3 6岁。有十二指肠球部溃疡病史 10余年 ,嗜烟酒。因呕血、便血住内科治疗。急诊胃镜检查十二指肠球部有直径 1ｃｍ溃疡合并出血 ,治疗中又连续出血 3次 ,量约 10 0 0ｍＬ ,转入外科行胃大部切除Ｂ -Ⅰ式吻合术 ,病理检查证实十二指肠球部溃疡出血。术后 3天胃管内颜色为草绿色 ,第 5天排便颜色为黄色。第 7天突发便血 3次并出现休克 ,血压 6 3 /3 2ｋ…     

十二指肠球部后壁潰疡并发出血治疗术式的选择

为探讨十二指肠球部后壁溃疡并发出血时手术方式的选择。 回顾性分析不同术式治疗35例十二指肠球部后壁溃疡并发出血的临床资料，术式包括Nissen法14例，Brancroft Plenk法8例，Graham法13例。观察各种术式的止血效果，近期并发症发生率等；比较3种术式的优缺点。结果示Nissen法术后无再出血病例，术后发生近期并发症2例（2/14），手术时间（180±60）min；Graham法术后无再出血病例，术后发生近期并发症3例（3/13），手术时间（190±70）min；Brancroft Plenk法术后再出血2例（2/8），术后发生近期并发症3例（3/8）, 手术时间（175±50）min。提示对十二指肠球部后壁溃疡并发出血的治疗，采用 Nissen法和Graham法止血效果较好，并发症少，但手术操作复杂；Brancroft Plenk法止血效果较差，并发症较严重，不宜采用。     

Risk factors associated with pressure ulcer recurrence after reconstruction: Analysis of a national database

In this study, we sought to clarify the patient traits and comorbidities that are associated with pressure injury recurrence following pressure injury reconstruction. An insurance claims database, PearlDiver, was used to conduct a retrospective cohort study. The two cohorts included patients who underwent pressure injury reconstruction without recurrence and patients who experienced recurrence with subsequent reconstruction. Multiple logistic regression analysis was used to identify risk factors for recurrence after reconstruction. Recurrence was associated with hypoalbuminemia (p < 0.05), paraplegia (p < 0.05), and osteomyelitis (p < 0.05). In patients with osteomyelitis, primary closure was associated with recurrence (p < 0.05) while flap reconstruction was not (p > 0.05). Osteomyelitis was not associated with recurrence after flap reconstruction. Prior to reconstruction, patients with osteomyelitis and hypoalbuminemia should have their nutrition and infection optimised.     

Benign rectal ulcer

Background: Although it is uncommon, significant bleeding per rectum presents one of the most difficult emergency problems. Bleeding from a rectal ulcer is not well recognized as a cause of such bleeding. Methods: From July 2000 through December 2000, 195 consecutive patients with significant blood loss per rectum were reviewed. Results: Forty-eight cases in whom significant gastrointestinal (GI) bleeding occurred following prior hospitalization were identified. Sources of bleeding were gastroduodenal in 38 cases (79%) and colorectal in 10 cases (21%). The causes of inpatient colorectal bleeding were benign rectal ulcer (n = 4), ischemic colitis (n = 3), neoplasia (n = 2), and diversion colitis (n = 1). Conclusion: The differential diagnosis for inpatients who develop new inpatient GI bleeding differs from that of patients who develop outpatient GI bleeding. Careful examination of the rectum following rectal instrumentation is critical. In addition to the standard resuscitative measures, the identification and treatment of rectal ulcers in this group of patients is of paramount importance. The treatment options for bleeding rectal ulcer include conservative therapy, cauterization, embolization, banding, and local excision.     

腹腔镜与开腹手术治疗老年消化性溃疡急性穿孔的对比研究

目的:比较腹腔镜与开腹手术治疗老年患者消化性溃疡急性穿孔的临床效果。方法:比较腹腔镜与开腹两种手术治疗52例老年患者消化性溃疡穿孔的疗效,两种术式的手术时间、术后下床活动时间、术后排气时间、术后止痛药使用率、术后并发症发生率、住院时间等影响因素。结果:两种手术的各项指标均有显著差异(P<0.05或P<0.01)。结论:腹腔镜手术修补具有患者创伤小、康复快、并发症少、住院时间短等优点,是治疗老年消化性溃疡急性穿孔较为理想的手术方式。     

腹腔镜行消化性溃疡急性穿孔修补手术的临床研究

目的探讨腹腔镜治疗消化性溃疡急性穿孔的临床价值。方法对腹腔镜手术组（腔镜组）53例和开腹手术组（开腹组）54例患者的手术时间、术中出血量、肠鸣音恢复时间、住院时间、使用镇痛剂例数、住院费用、术后切口及腹腔感染例数等指标进行比较。结果腔镜组术中出血量、术后肠鸣音恢复时间、住院时间、使用镇痛剂等指标均显著小于开腹组（P〈0．05）。结论腹腔镜手术具有侵袭性小、腹腔干扰小、术后痛苦小、肠功能恢复快、住院时间短等优点，可成为治疗消化性溃疡急性穿孔优先选择的治疗方法。     

超声诊断十二指肠球部溃疡穿孔

目的探讨十二指肠球部溃疡穿孔的超声表现特征,评价超声诊断十二指肠球部溃疡穿孔的价值。方法回顾性分析25例手术证实的十二指肠球部溃疡穿孔患者的彩色多普勒声像图特点,分别计算超声对十二指肠溃疡、腹腔游离气体、腹腔积液及局部包块的检出率,并与X线检查结果进行对比。结果25例十二指肠球部溃疡穿孔患者,术前超声检查提示十二指肠球部溃疡21例,腹腔游离气体18例,腹腔积液25例,腹部包块14例。X线平片或透视发现膈下游离气体21例,未能显示腹腔积液及腹部包块,更无法显示十二指肠球部溃疡的直接征象。结论对于十二指肠球部溃疡穿孔,超声在显示腹腔游离气体方面与X线检查相当,还可显示腹腔积液、肿块等X线无法显示的间接征象,尤其是可部分显示十二指肠球部溃疡的直接征象,弥补了X线检查的不足,是十二指肠球部溃疡穿孔的有效检查方法。     

Giant marginal ulcer

Marginal ulcer is a well-known complication of gastroenterostomy. It occurs in 3% of patients post-Billroth II subtotal gastrectomy; it occurs in less than 1% if truncal vagotomy is included but in up to 30% of patients with gastroenterostomy without vagotomy [10, 11, 14, 16]. These ulcers occur at the anastomosis, but always on the jejunal side, and are known to develop complications of their own — e.g., intractable pain, hemorrhage, obstruction, perforation, and fistula formation [6, 8, 17]. Prior to the advent of upper-GI endoscopy the main method of diagnosis was by history and upper GI series but the accuracy of the upper-GI series was about 50% or less. Now that upper-GI endoscopy is available, the accuracy of diagnosis is 95% or better. Since truncal vagotomy has been widely adopted as an integral part of gastric surgery — e.g., antrectomy, hemigastrectomy, subtotal gastrectomy, and gastroenterostomy — the incidence of marginal ulcer has declined. The use of cimetidine, ranitidine, famotidine, omeprazole, sucralfate, and antacids has improved the medical management of duodenal ulcer to such a degree that in recent years there is much less need for surgical intervention and thus the incidence of marginal ulcer has declined even more. In addition, the H-2 blockers and omeprazole can be used in patients with marginal ulcer and achieve healing; therefore complications that so frequently required surgical intervention are much less frequent [3, 12]. This report describes the clinical course of a patient with a virulent form of marginal ulcer and recurrent gastric bezoars, who was 5 years post truncal vagotomy and hemigastrectomy, with no evidence of a Zollinger-Ellison syndrome and low gastric acid as determined by two studies.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), San Antonio, Texas, USA, 1988     

腹腔镜在治疗十二指肠溃疡穿孔所致急性腹膜炎中的应用体会

目的探讨腹腔镜技术在治疗十二指肠溃疡穿孔引起的急性腹膜炎中的作用,为腹腔镜的临床应用提供科学依据。方法利用腹腔镜施行十二指肠溃疡穿孔修补的56例病例,观察疗效。结果所有病人无中转开腹,手术顺利,术后恢复顺利,未出现近期相关并发症。腹膜炎各项相关指标术后3 d基本恢复正常。结论电视腹腔镜对十二指肠溃疡穿孔引起的急性腹膜炎有较好的治疗作用,因此在临床上有进一步的推广利用价值。     

Healing of chronic venous ulcer with topical sevoflurane

The present study assesses the efficacy and safety of topical sevoflurane in chronic venous ulcers and its impact on analgesia and healing. This retrospective study included 30 patients older than 65 years with painful refractory chronic venous ulcers. Patients were treated with topical sevoflurane prior to the usual ulcer cleaning every 2 days for a period of 1 month. Treatment was initiated with a saline solution, followed by direct irrigation of 1 ml of liquid sevoflurane over the wound size, which was measured as cm². Sevoflurane had a fast, intense and long‐lasting analgesic effect. Latency time ranged from 2 to 7 minutes (3·9 ± 1·5 minutes), and duration varied from 8 to 18 hours (12 ± 2·9). The mean ulcer size was 8·4 ± 9·7 cm². There was a progressive decrease in size in all patients, with a mean size of 4·2 ± 5·4 cm² at the end of the study. There were no adverse systemic effects. Local adverse effects were mild and transient, including pruritus, erythema and heat. Topical sevoflurane is a new, efficient and safe therapeutic alternative in painful chronic venous ulcers, refractory to usual analgesic treatment. It can improve the ulcer‐healing process that shortens the cicatrisation period.     

Non healing leg ulcer infected with Stenotrophomonas maltophilia: first reported case from India

Stenotrophomonas maltophilia is a recently described organism which was mainly reported either in nosocomial setup, or in immunosuppresed individuals. This was rarely reported as cutaneous pathogenic organism causing cellulitis-like lesion, paronychia, mucocutaneous ulcers and ecthyma gangrenosum in immunocompromised individuals. Here we describe a case of leg ulcer caused by S. maltophilia in an immuno-competent patient. The infection was possibly community acquired as the patient had no exposure to hospital environment. The bacillus was sensitive to cotrimoxazole and levofloxacin, and the patient was successfully treated with cotrimoxazole. Our case is unique not only because it is probably the first ever case of leg ulcer caused by S. maltophilia, but also because of its unusual occurrence in immunocompetent patient.     

Marjolin ulcer: an overlooked entity

Marjolin ulcer is a well-defined, but uncommon malignant ulcer that occurs in chronic wounds and cutaneous scars. Jean-Nicolas Marjolin was credited with describing this phenomenon in 1828. This entity is frequently overlooked and therefore inadequately treated leading to a poor prognosis. The malignant transformation of an ulcer is most commonly associated with burn scars, but has been reported in many other types of chronic, non healing wounds such as traumatic wounds, venous stasis and chronic pressure ulcers, fistulas, lacerations and leprosy ulcers. Development of malignancy tends to be slow with an average time of approximately 25 years. Various theories concerning pathogenesis of Marjolin ulcer have been proposed. Well-differentiated squamous cell carcinoma (SCC) is the most common histological type of Marjolin ulcer. Biopsy with histopathologic interpretation remains the gold standard for the diagnosis, with radical surgical excision being the treatment of choice. A high index of suspicion should be held by any health care provider when evaluating a chronic, non healing wound. This is a case report of a Marjolin ulcer arising on the left buttock of a patient with a long-standing history of a traumatic wound.