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[我们对食管和胃腐蚀性损伤后的态度]

[Our attitude in esophageal and gastric post-caustic lesions].

作者信息

Gâdea V, Petrescu D, Gâdea E, Bosman A, Olaru G, Alexandrescu M, Lazăr A

机构信息

Spitalul Judeţean Alexandria, Teleorman.

出版信息

Chirurgia (Bucur). 2000 May-Jun;95(3):273-7.

Abstract

The authors present the experience of the surgery section in patients treatment with oesophagian or gastric lesions after caustic substances ingestion. From a group of 70 patients who were treated in a conservative way (with medicines and dilatations) 60 of them returned to the surgery for nourishment gastrostomy. In two cases, the oesophagian and gastric lesions was established preoperations trough radiologic examination and in thirteen cases the lesions were found intraoperation. The adopted attitude is exemplified presenting a case. Under a general anaesthesia is done a limited resection (about 3 cm) with termino-terminal anastomosis of the stenosed antral area keeping the vascular arches of the little and big gastric curvature. A minimal a la Gavriliu gastrostomy is mounted on the vertical area of the little curvature. Through the gastrostomy (Petzzer) probe is put a tube of perfusor to the first jejununal ansa. In the first 48 hours the Petzeer is used for the gastric drainage in the perfusor probe for feeding. After 48 hours the jejununal probe is taken away and the gastrostomic feeding begins. After six mouths from the caustic ingestion 25 patients come back again for oesophagian reconstruction. For 24 patients the Gavriliu I, II proceeding is applied and for a case it is used the small intestine ansa. They lost 3 patients (2 with gastric tube and 1 with intestinal ansa). The evolution in 24 years time was very good.

摘要

作者介绍了外科在腐蚀性物质摄入后食管或胃部病变患者治疗方面的经验。在一组70例接受保守治疗(药物和扩张治疗)的患者中,有60例因营养性胃造口术而再次接受手术。2例患者术前通过放射学检查确诊食管和胃部病变,13例患者术中发现病变。通过一个病例举例说明所采取的治疗方法。在全身麻醉下,对狭窄的胃窦区域进行有限切除(约3厘米),并进行端端吻合,保留胃小弯和胃大弯的血管弓。在胃小弯垂直区域做一个最小的加夫里留胃造口术。通过胃造口术(佩策尔)将一根灌注管插入空肠第一袢。在最初的48小时内,使用佩策尔进行胃引流,通过灌注管进行喂养。48小时后,取出空肠管,开始经胃造口喂养。腐蚀性物质摄入6个月后,25例患者再次接受食管重建手术。24例患者采用加夫里留I、II手术方法,1例患者使用小肠袢。他们有3例患者死亡(2例使用胃管,1例使用肠袢)。24年的随访结果非常好。

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