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頁籤選單縮合
題名 | Free Perforation of Marginal Ulcer=邊緣性潰瘍穿孔的外科治療 |
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作者 | 黃燦龍; |
期刊 | 中華民國外科醫學會雜誌 |
出版日期 | 19860900 |
卷期 | 19:4 1986.09[民75.09] |
頁次 | 頁343-347 |
分類號 | 416.24 |
語文 | eng |
關鍵詞 | 邊緣性潰瘍穿孔; 外科治療; |
中文摘要 | 邊緣性潰瘍穿孔是胃部手術後的一種遲發性併發症,臨床上並不多見。其發生的原因與邊緣性潰瘍的病因相同,卽主要為以前的胃次全切除手術時胃切除不足,殘留胃竇及Zollinger-Ellison Syndrome等。 長庚紀念醫院在過去五年間,共經驗了十九例邊緣性潰瘍穿孔而接受緊急手術的病人,佔同期間住院診斷為邊緣性潰瘍之160位病人的百分之十一點九。這些病例中,有12例接受穿孔處的單純縫合,其中兩例加作迷走神經主幹切除術;另有七例則接受胃腸吻合處的切除及再吻合,其中只有一位病人被發現有殘留胃竇而予切除。手術後,在前十二位病人組中有四位病人死於縫合處失敗引起的敗血症,這四位病人都因開刀時情況不好而未加作迷走神經主幹切除術。而後七位病人組,均於手術後順利康復出院。我們發現如果手術時機遲於症狀發生後24小時,則病人的術後併發症及死亡率均明顯增加;另外病人出院後追踪結果顯示,六位未加作迷走神經切除而只作穿孔處單純縫合的病人中,有四位仍然有明顯的邊緣性潰瘍症狀仍在。 對於邊緣性潰瘍穿孔的手術治療,只要病人情況尚好,應採取確切的根治手術,即如有殘留胃竇應予切除,如係胃體剩存太多,則應予切除部份胃體後,再作吻合或加作迷走神經主幹切除術。至於當病人情況危急時,則只作簡單的穿孔縫合;而當術後病人情況轉趨穩定,應對其作詳細檢查以確定邊緣性潰瘍發生的原因,再于長期藥物理制或自擇期作根治手術。 |
英文摘要 | Free perforation of marginal ulcer is uncommon. In the past five year, we experienced 19 cases of freely perforated marginal ulcer, or 11.9% of 160 cases of marginal ulcer, most cases were referred from other hospitals. Twelve patients were treated with simple closure of the perforation and two of them with additional truncal vagotomy. Seven patients were treated with revision of their gastrojejunostomy and one of them underwent resection of retained gastric antrum. Four of the patients treated by simple closure without truncal vegotomy died due to sepsis, a 21% operative mortality. Postoperative follow-up revealed most of the surviving patients did well, except 4, who underwent simple closure alone and still suffered from epigastralgia. The operative morbidity and mortality increased if operation was delayed more than 24 hours. The choice of operative procedure should include definitive treatment to correct the original inadequate resection or resect. the retained gastric antrum, unless the patient's condition is critical during operation. Postoperative studies should be completed to find any other possible etiology for the marginal ulcer. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。