Printen K J, Scott D, Mason E E
Arch Surg. 1980 Apr;115(4):525-7. doi: 10.1001/archsurg.1980.01380040147026.
Introduction of gastric bypass as treatment for morbid obesity in 1966 caused over its ulcerogenic potential as an antral exclusion procedure. However, in only 20 of our 653 patients has marginal ulceration developed. Predominant symptoms were epigastric pain, occult gastrointestinal bleeding, and vomiting. Barium contrast roentgenography was as diagnostically accurate as endoscopy in these lesions. Objective measurement ensuring creation of a gastric reservoir of 50 mL maximum size reduced the incidence of marginal ulcer from 3.8% to 0.98%. Upper pouch size determined the mode of therapy. Nonoperative therapy was successful in patients with small pouches, but did not relieve symptoms of patients with large reservoirs. Truncal vagotomy and resection of redundant upper pouch was the preferred operative approach in these patients.
1966年胃旁路手术作为病态肥胖的治疗方法被引入，因其作为一种胃窦旷置手术具有致溃疡的潜在风险而受到关注。然而，在我们的653例患者中，仅有20例发生了吻合口溃疡。主要症状为上腹部疼痛、隐匿性胃肠道出血和呕吐。在这些病变中，钡剂造影X线检查与内镜检查的诊断准确性相当。客观测量确保创建最大容量为50 mL的胃贮袋，使吻合口溃疡的发生率从3.8%降至0.98%。上袋大小决定了治疗方式。非手术治疗对小胃袋患者有效，但不能缓解大贮袋患者的症状。迷走神经切断术和切除多余的上袋是这些患者首选的手术方法。
