Prişcu A, Palade R, Medlej A H, Grigoriu M
Clinica de chirurgie I, Spitalul Universitar, Bucureşti.
Chirurgia (Bucur). 1994;43(2):1-6.
The work analyses a number of 283 patients suffering from gastric ulcer, which were hospitalised and operated between 1981-1991. In 64% of cases the surgical treatment decision was an emergency one for major complications of this disease such as: the upper digestive hemorrhage (27%), penetration (22%), perforation (11%), digestive stenosis (4%). In 36% of cases the decision of operation was taken for different reasons: unsatisfactory evolution under the conservatory treatment, the existence of an irreparable anatomic lesion, the recurrent ulcer or the difficulty of differential diagnosis between gastric ulcer and gastric carcinoma. It is important to indicate that the two of the major investigations: the barium transit and the fiber gastroscopy failed in giving a correct relation in 5 to 10% between gastric ulcer and gastric carcinoma. In 87% of patients it was performed the gastric resection type Péan. The lifting of the lesion in 7% of our observations needed the gastric resection on type Pochet. In the gastric ulcers Johnson II type, when the duodenal lesion couldn't be lifted we added to the Hoffmeister-Finsterer gastric resection type with truncal vagotomy. In 9% of patients with perforated or hemorrhagic gastric ulcer, the vital rise was a major one, so we performed only suture the lesion. We registered 3 deaths (1.06%).
该研究分析了1981年至1991年间住院并接受手术治疗的283例胃溃疡患者。在64%的病例中，手术治疗决策是针对该疾病的主要并发症而做出的紧急决定，这些并发症包括：上消化道出血（27%）、穿透（22%）、穿孔（11%）、消化性狭窄（4%）。在36%的病例中，手术决策是出于不同原因做出的：保守治疗效果不理想、存在无法修复的解剖病变、复发性溃疡或胃溃疡与胃癌鉴别诊断困难。需要指出的是，两项主要检查：钡剂造影和纤维胃镜检查在5%至10%的病例中未能正确区分胃溃疡和胃癌。87%的患者接受了佩安式胃切除术。在7%的观察病例中，病变的切除需要采用波切特式胃切除术。对于约翰逊II型胃溃疡，当十二指肠病变无法切除时，我们在霍夫迈斯特-芬斯特勒胃切除术的基础上增加了迷走神经干切断术。在9%的穿孔或出血性胃溃疡患者中，生命体征改善显著，因此我们仅对病变进行了缝合。我们记录到3例死亡（1.06%）。
