Richelme H, Bernard J L, Mouroux J, Benchimol D
Ann Chir. 1989;43(1):58-61.
The authors reviewed the emergency treatment of 64 duodenal ulcers operated during the haemorrhagic period in order to evaluate the results of an approach adapted to the site of the ulcer and to the lesions observed. Twenty-four ulcers were situated in the post-bulbar region (37.5%) and need to be considered separately as their anatomical situation and the frequently callous and burrowing nature raise difficult problems in the diagnosis and surgical approach. Conservative treatment (vagotomy, pyloroplasty, direct suture) was possible in 75% of cases. Sixteen gastrectomies (25%) were necessary because of the severity of the duodenal disease with a significantly higher rate in the case of post-bulbar ulcers. The overall postoperative mortality was 25%; it was due to a surgical cause in one half of cases. The surgical morbidity was dominated by recurrent haemorrhages (11%) with 85% mortality. The authors believe that suture vagotomy, which is the basic treatment for bulbar ulcers, also constitutes treatment of choice in the post-bulbar variety when the duodenum appears to be suturable after haemostasis. In the opposite case, duodenal resection is necessary and should extend beyond the ulcer crater. In every case, identification of the common bile duct and the papilla constitutes an essential precaution.
作者回顾了64例在出血期接受手术治疗的十二指肠溃疡患者的急诊治疗情况，以评估一种根据溃疡部位和观察到的病变而调整的治疗方法的效果。24例溃疡位于球后区域（37.5%），由于其解剖位置以及常见的硬结和穿孔性质，在诊断和手术方法上会引发难题，因此需要单独考虑。75%的病例可行保守治疗（迷走神经切断术、幽门成形术、直接缝合）。由于十二指肠疾病严重，16例行胃切除术（25%），球后溃疡患者的发生率明显更高。术后总体死亡率为25%；其中一半病例是由手术原因导致的。手术并发症以复发性出血为主（11%），死亡率为85%。作者认为，缝扎迷走神经切断术作为球部溃疡的基本治疗方法，当十二指肠在止血后似乎可缝合时，也是球后溃疡的首选治疗方法。反之，则需要行十二指肠切除术，且切除范围应超出溃疡灶。在每种情况下，识别胆总管和乳头都是至关重要的预防措施。
