Stulhofer M
Acta Chir Iugosl. 1980;27 Suppl 2:95-101.
Acute gastroduodenal mucosal lesions are observed following shock, sepsis, trauma, bat also after the ingestion of certain substances (alcohol) and in the course of severe, chronic medical illness. The so-called cushing ulcus should probably be separated from the clinical syndrome of stress ulcer. We must also exclude without any discussion reactivated chronic duodenal or ventricular ulcers with their complications, often manifested after serious trauma or illness. Digestive complaints are absent from the history of illness. The earliest manifest sign is in most cases severe gastrointestinal haemorrhage. It appears that the presence of Hydrogen ions in gastric contents and mucosal ischaemia are required for stress ulcer to develop, in which process damage to the "mucosal barrier" is also instrumental. The basic diagnostics is endoscopy. Angiography is only indicated in patients where endoscopy has failed. Conservative therapy brings haemorrhage under control in most cases. Surgery is indicated only if conservative therapy has proved inadequate to control bleeding or in cases of free perforation. Optimal surgical treatment remains a matter of discussion since no surgical method, except total gastrectomy, can protect the patient from recurrent haemorrhage.
急性胃十二指肠黏膜病变可见于休克、脓毒症、创伤后，也可见于摄入某些物质（酒精）后以及严重慢性疾病过程中。所谓的库欣溃疡可能应与应激性溃疡的临床综合征相区分。我们还必须毫无争议地排除因严重创伤或疾病后常出现的慢性十二指肠或胃溃疡复发及其并发症。病史中无消化系统主诉。在大多数情况下，最早出现的明显体征是严重的胃肠道出血。应激性溃疡的发生似乎需要胃内容物中氢离子的存在和黏膜缺血，在此过程中，“黏膜屏障”受损也起了作用。基本诊断方法是内镜检查。仅在内镜检查失败的患者中才考虑血管造影。在大多数情况下，保守治疗可控制出血。仅在保守治疗证明不足以控制出血或出现游离穿孔的情况下才考虑手术。由于除全胃切除术外，没有任何手术方法能保护患者免于再次出血，因此最佳手术治疗仍存在争议。
