Brehant O, Duval H, Dumont F, Fuks D, Deshpande S, Verhaeghe P, Yzet T, Bartoli E, Brazier F, Mauvais F, Lobjoie E, Dupas J L, Regimbeau J M
Departments of Digestive Surgery, University Hospital, University of Picardie, Place Victor Pauchet, 80054 Amiens 01, France.
Hepatogastroenterology. 2008 Jul-Aug;55(85):1327-31.
BACKGROUND/AIMS: Endoscopic hemostasis and proton pump inhibitors (PPI) have decreased the incidence of rebleeding and reduced the need for surgery for bleeding duodenal ulcer (BDU). The gold standard surgical treatment of BDU remains vagotomy-antrectomy. Currently, no recommendation is made on the best procedure when emergency surgery is necessary. The aim of this study was to assess the results of a systematic conservative treatment (CT): under-running bleeding gastroduodenal artery (GDA) and ulcer suture through a duodenotomy with (CT+L group) or without (CT group) GDA double ligation along with continuous intravenous PPI.
From 1995 to 2006, 22 consecutive patients (11 per group) underwent emergency surgery for BDU. Mean age was 63 +/- 18 years, ASA score 2.64 +/- 0.7. Ten patients (45%) presented collapse. Mean transfusion number was 11 +/- 9, number of therapeutic endoscopies 1.7 +/- 1, and Rockall score 6 +/- 2.
Overall, 2 patients (9%) had rebleeding and 5 patients (22%) died. No death was reported secondary to rebleeding. In the CT+L group, 9 patients (82%) had intravenous PPI, no patient had rebleeding and 2 patients died (22%).
Surgical CT of BDU with continuous PPI is effective, with a low rate of rebleeding. The standard use of vagotomy-antrectomy is questionable.
背景/目的：内镜止血和质子泵抑制剂（PPI）降低了十二指肠溃疡出血（BDU）的再出血发生率，并减少了手术需求。BDU的金标准手术治疗仍然是迷走神经切断术-胃窦切除术。目前，对于必要时的急诊手术最佳术式尚无推荐。本研究的目的是评估一种系统性保守治疗（CT）的结果：通过十二指肠切开术对出血的胃十二指肠动脉（GDA）进行潜行缝合及溃疡缝合，GDA双重结扎组（CT+L组）或不结扎组（CT组），同时持续静脉输注PPI。
1995年至2006年，22例连续的BDU患者（每组11例）接受了急诊手术。平均年龄为63±18岁，美国麻醉医师协会（ASA）评分2.64±0.7。10例患者（45%）出现休克。平均输血量为11±9，治疗性内镜检查次数为1.7±1，罗卡尔评分6±2。
总体而言，2例患者（9%）发生再出血，5例患者（22%）死亡。未报告因再出血导致的死亡。在CT+L组，9例患者（82%）接受了静脉PPI治疗，无患者发生再出血，2例患者死亡（22%）。
BDU的手术CT联合持续PPI治疗有效，再出血率低。迷走神经切断术-胃窦切除术的标准应用值得质疑。
