Camprodon Ricardo A M, Al-Ghnaniem Reyad, Camprodon Ricard
Department of Surgery, King's College Hospital, London, England.
Arch Surg. 2003 Jul;138(7):757-61; discovery 762. doi: 10.1001/archsurg.138.7.757.
A transgastric approach may be used succesfully for the treatment of posterior juxtacardial ulcers presenting with massive bleeding.
Eight patients were admitted during a 6-year period with acute massive upper gastrointestinal bleeding caused by posterior juxtacardial ulcers. All patients had signs of profound hypovolemic shock, and initial endoscopic control was achieved in 3 patients. They all underwent surgery after endoscopy. At operation, the ulcer was approached through an anteromedial gastrostomy and hemostasis was achieved by transfixing stitches. Ulcers were excised whenever possible, or excluded if adherent posteriorly. Four-quadrant biopsy was taken for frozen section to exclude malignancy. Both anterior and posterior gastric walls were then closed with nonabsorbable suture material.
There were 6 men and 2 women with a mean age of 73 years. Hemoglobin levels ranged from 5.2 to 8.0 g/dL. Five patients underwent emergency surgery within 28 hours of admission. The diameter of the ulcers ranged from 2 to 5 cm. Ulcerectomy was performed in 6 cases. In the remaining 2 patients, the crater of the ulcer was adherent to the diaphragm and required exclusion from the gastrointestinal tract. None of the ulcers proved to be malignant, and there were no operative deaths. Patients were followed up for a mean of 3 years with no complications.
Satisfactory results can be achieved with a transgastric approach to these rare ulcers. This allows definitive treatment while avoiding major gastric resection with its potential complications.
经胃途径可成功用于治疗伴有大量出血的后位近心尖溃疡。
在6年期间，8例因后位近心尖溃疡导致急性大量上消化道出血的患者入院。所有患者均有严重低血容量休克体征，3例患者通过内镜初步控制出血。他们均在内镜检查后接受手术。手术时，通过胃前内侧造口术接近溃疡，通过贯穿缝合止血。只要可能，就切除溃疡，若溃疡与后方粘连则予以旷置。取四象限活检做冰冻切片以排除恶性肿瘤。然后用不可吸收缝线材料缝合胃前后壁。
6例男性，2例女性，平均年龄73岁。血红蛋白水平为5.2至8.0g/dL。5例患者在入院后28小时内接受急诊手术。溃疡直径为2至5cm。6例行溃疡切除术。其余2例患者，溃疡底部与膈肌粘连，需将其与胃肠道旷置。所有溃疡均未证实为恶性，无手术死亡病例。患者平均随访3年，无并发症发生。
经胃途径治疗这些罕见溃疡可取得满意效果。这既能实现确定性治疗，又能避免胃大部切除术及其潜在并发症。
