Sabo S Y, Ameh E A
Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
East Afr Med J. 1999 Dec;76(12):690-2.
To characterise the pattern and pathology of obstructing duodenal ulcers in Zaria, Nigeria in the last seventeen years.
A retrospective study.
Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Fifty eight patients who had surgery for obstructing duodenal ulcer.
The mean age was 36.6 years and male/female was ratio 3.6:1. The frequency of obstruction has been on an increase, reaching a peak in 1995 and has remained high. This period coincided with a fall in the frequency of perforation. Obstruction was due to cicatrisation in 48%, cicatrisation and adhesions in 28%, adhesions alone in 16% and inflammatory oedema in eight per cent. Three patients with adhesion had evidence of sealed or treated perforation. Seventy one per cent of the adhesions occurred during the period of rapid rise in the frequency of obstruction. Truncal vagotomy and drainage was performed after three to five days of nasogastric drainage of the stomach. Post-operative gastric atony occurred in one patient and mortality was 1.7%. There was one short term recurrence.
Gastric outlet obstruction is now the commonest indication for duodenal ulcer surgery in this population. Obstruction need not be due to cicatrisation alone. Peripyloric adhesion, perhaps from previous perforation is often the cause of obstruction. Prolonged gastric drainage before and after surgery is not necessary. Truncal vagotomy and drainage is an effective treatment.
描述过去十七年尼日利亚扎里亚地区梗阻性十二指肠溃疡的发病模式及病理特征。
一项回顾性研究。
尼日利亚扎里亚阿马杜·贝洛大学教学医院外科。
58例因梗阻性十二指肠溃疡接受手术的患者。
平均年龄为36.6岁，男女比例为3.6:1。梗阻发生率呈上升趋势，1995年达到峰值且一直居高不下。这一时期穿孔发生率下降。梗阻原因中，瘢痕形成占48%，瘢痕形成与粘连占28%，单纯粘连占16%，炎性水肿占8%。3例粘连患者有穿孔封闭或已治疗的证据。71%的粘连发生在梗阻发生率快速上升时期。在胃进行三到五天的鼻胃引流后，实施迷走神经干切断术和引流术。1例患者术后发生胃无力，死亡率为1.7%。有1例短期复发。
胃出口梗阻目前是该人群十二指肠溃疡手术最常见的指征。梗阻不一定仅由瘢痕形成引起。幽门周围粘连，可能源于既往穿孔，常是梗阻的原因。手术前后无需长时间进行胃引流。迷走神经干切断术和引流术是一种有效的治疗方法。
