急诊胃大部切除术治疗胃十二指肠溃疡穿孔

目的 探讨适用于基层医院的胃十二指肠溃疡急性穿孔的手术治疗方法。方法 对l99l～2001年收治的胃十二指肠溃疡急性穿孔行急诊胃大部切除术的84例患者临床资料及随访结果进行回顾性分析。结果 84例急诊胃大部切除术的病人术后恢复顺利，痊愈出院，无死亡病例。通过l～5年的随访，患者一般在术后3～4个月生活，体质恢复到正常水平，能胜任日常工作。l例(1．2％)在2年后出现吻合口溃疡。结论 胃大部切除术去除了溃疡病灶和泌酸环境，达到了根治的目的，且手术安全性高。因此，在基层医院，在患者条件许可时，对胃十二指肠溃疡穿孔应尽可能行胃大部切除术治疗。     

胃大部分切除术治疗胃十二指肠溃疡大出血的近期疗效观察

目的观察分析胃十二指肠溃疡大出血患者胃大部分切术治疗的近期疗效。方法回顾分析2010-01—2011-06在我院实施胃大部手术切除治疗的53例胃十二指肠溃疡大出血患者的手术临床资料。结果 53例患者中48例实施急诊手术,5例采用择期手术,手术平均时间为(52.35+8.67)min,术中平均出血量为(132.90+10.92)mL、术后胃肠持续加压平均时间为(2.66+0.32)d、胃肠功能16～48 h恢复,所有患者均痊愈出院,平均住院(8.35+1.57)d,术后无复发,且仅出现1例切口感染,1例吻合口瘘,无其他并发症出现。结论胃大部分切除术在胃十二指肠溃疡大出血治疗中安全性及治愈率高,无严重并发症出现且可有效避免术后复发,近期疗效显著。     

介入治疗在出血性胃十二指肠溃疡病术后大出血的应用评价

目的 评价出血性胃十二指肠溃疡患者在胃大部切除术后大出血时予以介入栓塞治疗的效果。方法 对我院1980～2002年间收治的49例出血性胃十二指肠溃疡患者,在胃大部切除术后大出血时的手术与介入治疗效果进行回顾性比较分析。结果 本组49例患者中,予以再手术治疗26例(再手术组),介入治疗23例(介入治疗组),均取得了较好的疗效。两组在治愈率、病死率、并发症及再出血发生率方面比较,差异无显著性意义(P>>0.05)。但平均住院日及输血量再手术组明显增多,两组比较,差异有极显著性意义(P<0.01)。结论 对于出血性胃十二指肠溃疡患者,术后大出血行介入栓塞治疗是安全有效的,应及早进行;对介人治疗效果不佳者应及时手术。     

胃大部切除术后近期再手术53例临床分析

胃大部切除术用于治疗胃十二指肠溃疡及其并发症,绝大多数能获得优良或满意疗效。但该手术并发症多,其中有一部分需再手术。为进一步提高胃大部切除术的质量,降低再手术率,对我院1976~1994年胃大部切除术后近期再手术53例患者的原因、预防及治疗进行了分析。1 1%#11临床资料53例患者中男49例,女4例,年龄17~61岁,平均45.6岁。其中14例由他院转来。第1次行胃大部切除术的原发疾病为:慢性十二指肠溃疡38例,其中15例合并穿孔或大出血;慢性胃溃疡15例,其中9例合并穿孔或大出血。手术方式:毕Ⅰ式4例;毕Ⅱ式49例,其中结肠前胃空肠吻合45例,结肠后吻合4例。空肠近端对胃大弯吻合44例,对胃小弯吻合5例。     

胃十二指肠溃疡急性穿孔手术治疗的临床观察

目的观察外科手术治疗胃、十二指肠溃疡穿孔的临床效果。方法对60例胃、十二指肠溃疡急性穿孔患者实施胃大部切除术或穿孔修补术,回顾性分析患者的临床资料。结果本组均顺利完成手术,术后发生十二指肠残端瘘1例、胃排空障碍1例、隔下脓肿1例,均经对症治疗后恢复,其余患者均痊愈出院。结论对胃、十二指肠溃疡穿孔患者应及时明确病灶部位及病变程度,合理选择术式,可降低术后并发症发生率,促进患者早期康复。     

胃十二指肠溃疡大出血治疗体会

目的探讨胃大部切除术治疗胃十二指肠溃疡大出血的疗效。方法将90例胃十二指肠溃疡大出血患者随机分为观察组和对照组,各45例。观察组采用胃大部切除术,对照组行内科保守治疗,比较2组的效果。结果观察组治愈率明显高于对照组,病死率和复发率远低于对照组。结论对诊断明确的胃、十二指肠溃疡大出血患者,应当果断采取手术治疗,具有根除病因、治愈率高,近期病死率和复发率低等优点。     

十二指肠溃疡急性穿孔不同手术方式疗效的比较研究

目的探讨十二指肠溃疡急性穿孔的不同外科手术方式的疗效。方法对120例十二指肠溃疡急性穿孔病人分别行开腹单纯穿孔修补术加用高选择性迷走神经切断术（Parietal Cell Vagotomy,以下简称PCV）、腹腔镜下穿孔修补加用PCV、开腹胃大部切除术。对其手术时间、住院时间、术后并发症、溃疡复发率进行比较观察。结果腹腔镜下十二指肠溃疡急性穿孔修补术＋PCV明显节省了手术时间、住院时间和减少了手术并发症,但与开腹胃大部切除术相比,溃疡复发率较高。结论腹腔镜下十二指肠溃疡急性穿孔修补加用PCV是较合理的选择,术后辅以制酸及抗Helicobacter pylori感染药物是必要的。开腹胃大部切除术已不再是治疗十二指肠溃疡急性穿孔的合理选择。     

上消化道大出血行胃大部切除术后再出血临床分析

目的探讨上消化道大出血行胃大部切除手术再出血的相关原因,并提出相应的预防措施。方法选取上消化道大出血行胃大部切除术后再出血患者22例,对术后再出血的原因进行分析,并提出相应预防策略。结果 22例患者均于术后72 h内再次出血,引起术后再出血的原因:吻合口缝合不严10例(45.45%),旷置溃疡出血7例(31.82%),应激性溃疡出血3例(13.64%),无明显原因2例(9.09%)。经治疗后22例患者痊愈12例,好转8例,死亡2例。结论借助内镜进行诊治、严格掌握手术指征、正确选择手术方式、规范进行手术操作,可有效减少上消化道大出血术后再次出血发生。     

十二指肠溃疡急性穿孔48例临床分析

目的　探讨十二指肠溃疡急性穿孔的手术治疗效果。方法　对 4 8例十二指肠溃疡急性穿孔实施以胃大部切除术为主的急诊手术治疗的总结分析。结果　本组无死亡病例 ,近期愈后良好 ,无十二指肠残端瘘及吻合口漏发生。结论　十二指肠溃疡急性穿孔以急诊胃大部切除术一期根治的方法疗效确切。规范的胃切除和对十二指肠残端的正确处理 ,是避免手术并发症发生的关键。     

腹腔镜治疗胃十二指肠急性大出血的体会

目的:探讨腹腔镜手术治疗胃十二指肠急性大出血的应用价值及手术技巧。方法:回顾分析2010年8月至2012年1月5例胃十二指肠急性大出血患者经胃镜确诊并初步止血后行腹腔镜手术的临床资料。其中胃窦巨大溃疡出血2例,十二指肠球后溃疡出血、胃底溃疡出血、胃间质瘤胃镜活检后出血各1例。结果:5例患者经胃镜确诊并初步止血后急诊行腹腔镜手术,疗效良好,无一例围手术期死亡,术后无手术相关并发症发生。结论:腹腔镜手术治疗胃十二指肠急性大出血术中能快速处理病灶,止血效果确切,具有较高的治疗价值。     

Surgical management of peptic ulcer disease today – indication, technique and outcome

Aims: The current surgical management of peptic ulcer disease and its outcome have been reviewed. Results: Today, surgery for peptic ulcer disease is largely restricted to the treatment of complications. In peptic ulcer perforation, a conservative treatment trial can be given in selected cases. If laparotomy is necessary, simple closure is sufficient in the large majority of cases, and definitive ulcer surgery to reduce gastric acid secretion is no longer justified in these patients. Laparoscopic surgery for perforated peptic ulcer has failed to prove to be a significant advantage over open surgery. In bleeding peptic ulcers, definitive hemostasis can be achieved by endoscopic treatment in more than 90% of cases. In 1–2% of cases, immediate emergency surgery is necessary. Some ulcers have a high risk of re-bleeding, and early elective surgery might be advisable. Surgical bleeding control can be achieved by direct suture and extraluminal ligation of the gastroduodenal artery or by gastric resection. Benign gastric outlet obstruction can be controlled by endoscopic balloon dilatation in 70% of cases, but gastrojejunostomy or gastric resection are necessary in about 30% of cases. Conclusions: Elective surgery for peptic ulcer disease has been largely abandoned, and bleeding or obstructing ulcers can be managed safely by endoscopic treatment in most cases. However, surgeons will continue to encounter patients with peptic ulcer disease for emergency surgery. Currently, laparoscopic surgery has no proven advantage in peptic ulcer surgery. Received: 11 January 2000 Accepted: 12 January 2000     

MANAGEMENT OF ACUTE BLEEDING GASTRIC MALIGNANCY

Gastric malignancy was the cause of bleeding in 35 of a consecutive series of 2260 cases (1.5%) treated with upper gastrointestinal haemorrhage. Fifteen patients came to emergency surgery (43%). In 13 of 30 early endoscopies performed the lesion was thought to be benign (43%) and seven of these cases came to emergency surgery. Two patients died after 15 emergency operations (13%) compared with 15 deaths after 109 emergency operations (14%) for benign gastric ulcer during the same period of study. A total of four patients with malignant ulceration died after surgery in 33 cases (12%), two after 15 emergency operations and two after 18 elective procedures. The only significant predictors of urgent surgery for malignant ulcer were shock on admission and active bleeding or visible vessel on endoscopy. Resection of gastric malignancy was performed in 29 patients during initial admission and in four cases at a subsequent admission giving a final resection rate of 91%. Of the 28 patients with adenocarcinoma, 19 had localized disease (Stage 1 or 11) (68%). Nine patients were treated by total gastrectomy, five at an initial elective procedure and four at a second procedurc.     

Results of stomach resection with Roux gastrojejunostomy for gastroduodenal ulcers]

In a follow-up study operative risk, postoperative functional disorders and incidence of anastomotic (recurrent) ulcer after partial gastrectomy with Roux-en-Y gastrojejunostomy for gastroduodenal ulcer were evaluated in 52 patients. Lethality for elective treatment was 0 and for emergency surgery (ulcer bleeding) 16.7%. 29.5% of the patients reported postoperative functional disorders. Because Roux-en-Y reconstruction prevented duodenogastric reflux, intragastric pH was low (median 2.2) and in the absence of ulcer protective, neutralizing reflux anastomotic ulcer occurred in 15.9% of the patients. With regard to the high rate of recurrent ulcer Roux-en-Y reconstruction after partial gastrectomy for primary ulcer surgery should be avoided and reconstruction procedures preferred, which guarantee duodenogastric reflux.     

Surgery of acute peptic ulcer haemorrhage

During the years 1973-1985, 145 patients with acute peptic ulcer haemorrhage were treated surgically at the Department of Surgery, Turku University Central Hospital. The bleeding site was gastric ulcer in 76 patients; 58 of these were treated by gastric resection and 17 by ulcer excision combined with vagotomy and pyloroplasty. Forty-two out of 69 patients with bleeding duodenal ulcer were treated with partial gastrectomy, the remaining with transfixion and vagotomy and pyloroplasty. The rebleeding rate was 2% and reoperation rate 9% among the patients who had a resection. In contrast 19% of the transfixed and 12% of ulcer excision cases rebled. The primary overall mortality was 12%; 44% of the patients with recurrent bleeding died. Because rebleeding was the most important cause of mortality, partial gastrectomy in bleeding gastric as well as duodenal ulcer may be preferable.     

Surgical management of gastroduodenal haemorrhage

We have presented a retrospective study of the surgical management of 299 patients bleeding from duodenal ulcer, gastric ulcer or gastritis. The overall mortality rate was 15%-5% for elective and 25% for emergency operations. The mortality increased with age and reached 50% for emergency operations in patients over the age of 70. Patients with low admission haemoglobin values, who had episodes of hypovolemic shock or who required immediate transfusions were also at risk. A Billroth I gastric resection proved to be the safest operative procedure. Based on our results, we are supporting a program calculated to reduce the mortality attending gastroduodenal bleeding, especially in those patients requiring an emergency operation. The basic principles of this program are constant observation, prompt diagnosis and early surgical intervention.     

FIVE YEARS‘ EXPERIENCE WITH PROXIMAL GASTRIC (HIGHLY SELECTIVE) VAGOTOMY

In the five-year period 1972 to 1976 the authors' preferred treatment for patients with chronic duodenal or prepyloric peptic ulcer requiring surgery was proximal gastric vagotomy. In spite of this preference, only two-thirds of such patients were so treated. Most patients with bleeding and stenosis were treated by bilateral truncal vagotomy and drainage, and a few by Polya gastrectomy. Proximal gastric vagotomy proved to be a safe elective operation without mortality and with a proven ulcer recurrence rate so far of 6%. Compared with those who had bilateral truncal vagotomy and drainage, the proximal gastric vagotomy patients complained less often of diarrhoea but more often of weight loss and reflux. Two patients have had persistent postprandial non-peptic pain, thought possibly due to upper gastric ischaemia.     

five years' experience with proximal gastric (highly selective) vagotomy.

In the five-year period 1972 to 1976 the author's preferred treatment for patients with chronic duodenal or prepyloric peptic ulcer requiring surgery was proximal gastric vagotomy. In spite of this preference, only two-thirds of such patients were so treated. Most patients with bleeding and stenosis were treated by bilateral truncal vagotomy and drainage, and a few by Pólya gastrectomy. Proximal gastric vagotomy proved to be a safe elective operation without mortality and with a proven ulcer recurrence rate so far of 6%. Compared with those who had bilateral truncal vagotomy and drainage, the proximal gastric vagotomy patients complained less often of diarrhoea but more often of weight loss and reflux. Two patients have had persistent postprandial non-peptic pain, thought possibly due to upper gastric ischaemia.     

Acute hemorrhage secondary to gastric ulcer. Results of emergency endoscopic treatment in 775 cases

The aim of this study was to investigate the effects of endoscopic injection therapy on the clinical outcome of patients with gastric ulcer bleeding. Seven hundred and seventy-five patients with gastric ulcer bleeding were observed over a 10-year period (January 1990 to May 2000) in the First Division of General Surgery of the University of Verona. The prognostic and therapeutic implications of endoscopic treatment of acute severe gastrointestinal bleeding were analyzed on the basis of medical history and clinical and endoscopic findings. The ulcers were classified according to Forrest's classification of bleeding activity. Endoscopic therapy was performed in 500 patients with active bleeding. Haemostasis was initially obtained in all patients except one. Rebleeding occurred in 13%. All these patients were treated endoscopically at the first attempt. Multivariate analysis revealed that recent surgery, ulcer site and Forrest classification independently influenced the recurrence rate. The mortality of the entire cohort studied was 8.1%. Only 31 patients (4%) underwent surgical treatment with a higher mortality compared to unoperated patients (19.3% vs 7.7%). Endoscopic treatment is a safe procedure with a low mortality and cost, and, if successful, substantially reduces the need for emergency surgery.     

贲门良性溃疡的外科治疗

目的 探讨贲门良性溃疡的外科治疗方法。方法 回顾分析21例贲门良性溃疡的临床表现、溃疡数目、部位和大小、术前X线和胃镜检查的结果、手术方式及并发症。结果 21例患者平均年龄近60岁;溃疡伴出血者占33．3％,伴穿孔者占23．8％;术前X线、胃镜检查诊断率分别为57．1％和100％;近侧胃大部切除术占85．7％,全胃切除术占14．3％;本组无手术死亡,无吻合口瘘等并发症。结论 近侧胃大部切除术,既可切除溃疡灶,又可减少胃酸分泌,且手术简便,是治疗贲门良性溃疡理想的术式。     

Surgical treatment of complicated ulcers of cardia and sub-cardia

Two hundred and two patients with ulcers of a proximal part of the stomach (17.5% of all patients with gastric ulcer) were treated. In 135 (64.9%) patients these ulcers were complicated: in 28 (20.7%) -- malignant ulcers, in 42 (31.1%) -- bleeding ulcers, in 53 (39.3%) -- penetrating ones. Surgery was performed in 142 (70.3%) patients. A high rate of complications dictates a need to reduce period of conservative treatment of such ulcers to 6 months -- 1 year. Distal and proximal resection of the stomach are main surgeries in elective surgical treatment of patients with benign ulcers of cardia and sub-cardia. In malignant transformation gastrectomy is the most preferable. Suturing is indicated in perforated and bleeding ulcers, and if it is impossible -- distal subtotal resection of the stomach.