Speranza V, Basso N
World J Surg. 1977 Jan;1(1):35-44. doi: 10.1007/BF01654729.
This article presents an analysis of acute gastroduodenal mucosal lesions (AGML) based on a review of current literature and the personal experience of the authors. The pathology of AGML involes two distinct types of lesions, namely, superficial erosions confined to the acid-secreting gastric mucosa and presenting as erosive hemorrhagic gastritis, and acute ulcers that occur in the alkaline gastric mucosa and duodenum. The etiology of these two lesions is very likely different. Acut gastroduodenal ulcers, best known as stress ulcers, are probably "peptic" lesions, whereas erosive hemorrhagic gastritis appears to be due to pathologic back diffusion of hydrogen ions caused by a breakdown of the gastric mucosal barrier as a result of endogenous factors, such as gastric mucosal ischemia, and sometimes exogenous factors, such as alcohol, urea, and acetylsalicylic acid. Catecholamine hypersecretion resulting from severe stress, such as occurs in hypovolemia, sepsis, and hypercapnea, contributes to ischemia of the gastric mucosa by producing splanchnic vasoconstriction. The key to the diagnosis of AGML is early endoscopy in all cases of upper gastrointestinal bleeding. Therapy for AGML should begin with a trial of medical measures directed at restoring effective perfusion of tissues and removing hydrogen ions from the stomach by gastric washing. Medical therapy is effective in 80% of patients with erosive hemorrhagic gastritis, but surgical treatment is usually required in acute gastroduodenal ulcer. When surgery is necessary for either type of lesion, vagotomy with hemigastrectomy appears to be the most effective operation. The personal experience of the authors has involved 36 patients with AGML who were treated in three periods between 1968 and 1976. The mortality rate of patients with AGML has been reduced from 50% in the first 2 years to zero in the last 2 years by the use of emergency endoscopy for diagnosis, appropriate medical therapy, properly timed and executed surgery, and, most recently, selective angiography.
本文基于对当前文献的综述以及作者的个人经验，对急性胃十二指肠黏膜病变（AGML）进行了分析。AGML的病理包括两种不同类型的病变，即局限于泌酸胃黏膜的浅表糜烂，表现为糜烂性出血性胃炎，以及发生在碱性胃黏膜和十二指肠的急性溃疡。这两种病变的病因很可能不同。急性胃十二指肠溃疡，即最广为人知的应激性溃疡，可能是“消化性”病变，而糜烂性出血性胃炎似乎是由于内源性因素（如胃黏膜缺血）以及有时外源性因素（如酒精、尿素和乙酰水杨酸）导致胃黏膜屏障破坏，氢离子发生病理性反向弥散所致。严重应激（如低血容量、败血症和高碳酸血症时出现的）引起的儿茶酚胺分泌过多，通过导致内脏血管收缩，促使胃黏膜缺血。AGML诊断的关键在于对上消化道出血的所有病例尽早进行内镜检查。AGML的治疗应首先尝试采取旨在恢复组织有效灌注并通过洗胃清除胃内氢离子的医疗措施。药物治疗对80%的糜烂性出血性胃炎患者有效，但急性胃十二指肠溃疡通常需要手术治疗。对于这两种病变中的任何一种，当有必要进行手术时，迷走神经切断术加半胃切除术似乎是最有效的手术方式。作者的个人经验涉及1968年至1976年期间分三个阶段治疗的36例AGML患者。通过使用急诊内镜进行诊断、适当的药物治疗、适时且恰当实施的手术，以及最近采用的选择性血管造影，AGML患者的死亡率已从前两年的50%降至最近两年的零。
