Guinier David, Destrumelle Nicolas, Denue Pierre Olivier, Mathieu Pierre, Heyd Bruno, Mantion Georges Andre
Liver Transplantation Unit, Department of Digestive Surgery, University Hospital, 2, place St. Jacques, 25000 Besançon, France.
World J Surg. 2009 May;33(5):1010-4. doi: 10.1007/s00268-009-9953-1.
The treatment of a bleeding chronic posterior duodenal ulcer, with bleeding recurrence or persistence despite endoscopic therapy, requires surgical treatment and constitutes a challenge for the surgeon; furthermore such chronic ulcers are often wide and sclerotic, so the surgeon needs to avoid the risk of recurrent bleeding if conservative surgery is applied. If radical surgery must be performed, the greater risk involves duodenal leakage, hepatic hilar injury, or pancreatic injury. This study aimed to evaluate the efficacy and complications arising from a surgical procedure, described by Dubois in 1971 (Gastrectomy and gastroduodenal anastomosis for post-bulbar ulcers and peptic ulcers of the second part of the duodenum. J Chir 101:177-186). This operation involves antroduonectomy with gastroduodenal anastomosis. It is similar to a Billroth I gastrectomy but without dissection of the ulcer.
We retrospectively studied the medical data of patients who underwent this procedure for the treatment of bleeding chronic posterior duodenal ulcers during the past 20 years.
There were 28 such patients admitted to our institution for emergency surgery, who went on to be treated by the Dubois procedure. Ulcerous disease was efficiently treated without rebleeding or duodenal leakage. The mortality rate was 17%; most deaths resulted from medical failure in older patients suffering from massive bleeding. The rate of medical complications reached 21%. Surgical complications developed in 14% of patients.
The Dubois antroduodenectomy is a safe and effective surgical procedure for the treatment of bleeding chronic duodenal ulcers. The number of fatal outcomes among patients with this condition remains high, particularly in older and vulnerable patients experiencing massive bleeding.
对于出血性慢性十二指肠后壁溃疡，尽管进行了内镜治疗，但仍有出血复发或持续，需要手术治疗，这对外科医生来说是一项挑战；此外，此类慢性溃疡通常范围广且硬化，因此如果采用保守手术，外科医生需要避免再次出血的风险。如果必须进行根治性手术，更大的风险包括十二指肠漏、肝门损伤或胰腺损伤。本研究旨在评估1971年由杜波依斯描述的一种手术方法（针对十二指肠球后溃疡和十二指肠第二部消化性溃疡的胃切除术和胃十二指肠吻合术。《外科杂志》101:177 - 186）的疗效和并发症。该手术包括胃窦十二指肠切除术及胃十二指肠吻合术。它类似于毕罗一式胃切除术，但不切除溃疡。
我们回顾性研究了过去20年中接受此手术治疗出血性慢性十二指肠后壁溃疡患者的医疗数据。
有28例此类患者因急诊手术入院，随后接受了杜波依斯手术治疗。溃疡疾病得到有效治疗，无再次出血或十二指肠漏。死亡率为17%；大多数死亡是由于老年患者大量出血导致的医疗救治失败。医疗并发症发生率达21%。手术并发症发生在14%的患者中。
杜波依斯胃窦十二指肠切除术是治疗出血性慢性十二指肠溃疡的一种安全有效的手术方法。患有这种疾病的患者中致命结局的数量仍然很高，特别是在经历大量出血的老年和脆弱患者中。
