The Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Dig Endosc. 2010 Jul;22 Suppl 1:S35-7. doi: 10.1111/j.1443-1661.2010.00966.x.
Recent important insights into the surgical treatment of bleeding peptic ulcer are reviewed in this article. Although the widespread use of endoscopic treatment and interventional radiology has reduced the number of surgical cases, surgery still plays a pivotal role in managing bleeding peptic ulcer. Failure to stop the bleeding by endoscopy and/or interventional radiology is the most important indication for emergency surgery. An early elective/planned surgery after the initial endoscopic control to prevent life-threatening rebleeding seems justified in patients who have risk factors for rebleeding, although its true efficacy still remains controversial. The surgical procedures in emergency situations should be limited to safe hemostasis. The addition of acid-reduction surgery may be unnecessary as a result of the increasing utilization of proton pump inhibitors. Angiographic embolization may be a less invasive alternative to surgery, and may further enhance endoscopic hemostasis.
本文综述了近期在出血性消化性溃疡外科治疗方面的重要进展。尽管内镜治疗和介入放射学的广泛应用已经减少了手术病例数量，但手术在处理出血性消化性溃疡方面仍起着关键作用。内镜和/或介入放射学未能止血是紧急手术的最重要指征。对于有再出血风险因素的患者，在初始内镜控制后早期进行选择性/计划性手术以预防危及生命的再出血似乎是合理的，尽管其真正疗效仍存在争议。在紧急情况下，手术程序应仅限于安全止血。由于质子泵抑制剂的应用日益增多，减少胃酸分泌手术可能没有必要。血管造影栓塞可能是一种比手术更具侵袭性的替代方法，并可能进一步增强内镜止血效果。
