Graupe F, Schwenk W, Mackrodt H G, Stock W
Chirurgische Abteilung, Marien-Hospital Düsseldorf.
Zentralbl Chir. 1994;119(1):11-6.
Acute bleeding of the upper gastrointestinal tract found in patients with arterial occlusive disease lead us to analyse the coincidence of arterial occlusive disease and pathological changes of the upper gastrointestinal tract. While waiting for reconstructive vascular surgery between 1986 and 1992 420 patients underwent esophago-gastro-duodenoscopy for preoperative risk assessment. In 59% endoscopy revealed pathological findings in the upper gastrointestinal tract. Inflammation was found in 61.6% of the patients, in 15% gastric ulcer. Patients with gastrointestinal symptoms had no significant more pathological findings in gastroscopy (p = 0.1). We excluded 9.3% patients from primary elective vascular surgery because of their severe pathological findings. 19 patients were operated on their gastrointestinal disease at first. In 7 patients we found an unknown carcinoma of the stomach. 5 patients got a resection of the stomach, in 2 patients an operation was unable. The diagnosis and therapy of risk factors are a major objective in the treatment of arterial occlusive disease. The results of the study stress the necessity of routinely performed endoscopy in patients awaiting vascular surgery. Beside a preoperative risk assessment this will lead to a lower incidence of serious gastrointestinal complications postoperatively.
在患有动脉闭塞性疾病的患者中发现上消化道急性出血，这促使我们分析动脉闭塞性疾病与上消化道病理变化的相关性。1986年至1992年期间，在等待血管重建手术时，420例患者接受了食管-胃-十二指肠镜检查以进行术前风险评估。59%的患者内镜检查发现上消化道有病理改变。61.6%的患者发现有炎症，15%有胃溃疡。有胃肠道症状的患者胃镜检查中病理改变并无明显更多（p = 0.1）。由于严重的病理改变，我们将9.3%的患者排除在一期择期血管手术之外。19例患者首先接受了胃肠道疾病手术。7例患者发现了未知的胃癌。5例患者接受了胃切除术，2例患者无法进行手术。危险因素的诊断和治疗是动脉闭塞性疾病治疗的主要目标。研究结果强调了在等待血管手术的患者中常规进行内镜检查的必要性。除了术前风险评估外，这将降低术后严重胃肠道并发症的发生率。
