Hölscher A H, Bollschweiler E, Mönig S P
Klinik und Poliklinik für Visceral- und Gefässchirurgie der Universität, Köln, Kerpener Strasse 62, 50937 Köln.
Internist (Berl). 2006 Jun;47(6):602, 604-6, 608, passim. doi: 10.1007/s00108-006-1625-8.
Ulcer surgery today concentrates on the complications of chronic ulcer disease, especially ulcer perforation and endoscopically uncontrollable ulcer bleeding. In this case the laparoscopic or open closure of the gastroduodenal defect or local hemostasis of the bleeding ulcer by laparotomy are the main aims of surgery. Elective operations due to recurrent gastric or duodenal ulcers have become rare. An indication for gastric ulcer resistant to conservative therapy could be persisting suspicion of malignancy whereas in duodenal ulcer gastric outlet obstruction represents a reason for surgery. If these indications are confirmed the classic procedures of gastric resection like Billroth I and Billroth II are performed whereas vagotomy is no longer used. Altogether ulcer surgery has become very safe although it is practiced quite rarely.
如今，溃疡手术主要针对慢性溃疡病的并发症，尤其是溃疡穿孔和内镜无法控制的溃疡出血。在这种情况下，腹腔镜或开放手术关闭胃十二指肠缺损或通过剖腹手术对出血性溃疡进行局部止血是手术的主要目的。因复发性胃溃疡或十二指肠溃疡而进行的择期手术已变得罕见。对保守治疗耐药的胃溃疡的手术指征可能是持续怀疑存在恶性肿瘤，而十二指肠溃疡导致的胃出口梗阻则是手术的一个原因。如果这些指征得到确认，则施行经典的胃切除术，如毕罗一式和毕罗二式，而迷走神经切断术已不再使用。总体而言，尽管溃疡手术实施得相当少，但已变得非常安全。
