Malheiros C A, Moreno C H, Rodrigues F C, Pereira V, Rahal F
Department of Surgery, Santa Casa School of Medicine, São Paulo, Brazil.
Int Surg. 1998 Apr-Jun;83(2):111-4.
In the surgical management of duodenal ulcers, the most feared complications are related to the treatment of the duodenal stump after Billroth lI-type gastric resections. Such complications are more evident in so-called 'difficult duodenum' cases, whose identification is directly related to the surgeon's experience. Among available techniques to avoid those complications, one is the treatment of the antralduodenal stump by the method of pre-pyloric exclusion and removal of antral mucosa, as proposed by Finsterer in 1918 and diffused by Bancroft in 1932. This method, however, was criticized, especially because of the possibility of retaining residual antral mucosa, which would be a determinant factor for the ulcer disease recurrence. The objective of the study was to verify whether the Finsterer-Bancroft operation is a valid alternative in the treatment of unresectable duodenal ulcers, as well as to encourage its application by less experienced surgeons, by the standardization of the surgical technique.
From April, 1984 to December, 1996 two hundred and six elective partial gastrectomies for duodenal ulcers were performed with Billroth II reconstruction. Of these, in thirty-one (15%), the Finsterer-Bancroft method was used. The patients' ages, varied between 23 and 65 years, constituting 25 males and 6 females. In all cases, surgery was indicated due to the presence of stenosis.
Three patients (9.7%) had complications. There was one death (3.2%) due to leakage of duodenal stump and peritonitis, one case of duodenal fistula (3.2%), and one case of ulcer recurrence (3.2%). All three complications were caused by inappropriate application of the method.
We conclude that the Finsterer-Bancroft operation is a valid alternative in the surgical treatment of chronic duodenal ulcers, when considered unresectable, and is within the reach of in-training and less experienced surgeons.
在十二指肠溃疡的外科治疗中，最令人担忧的并发症与毕罗Ⅱ式胃切除术后十二指肠残端的处理有关。此类并发症在所谓“困难十二指肠”病例中更为明显，而对其识别直接取决于外科医生的经验。在现有的避免这些并发症的技术中，有一种是1918年由芬斯特勒提出并于1932年由班克罗夫特推广的经幽门预闭和胃窦黏膜切除术治疗胃窦十二指肠残端。然而，该方法受到了批评，尤其是因为可能残留胃窦黏膜，这将是溃疡病复发的决定性因素。本研究的目的是验证芬斯特勒 - 班克罗夫特手术在治疗无法切除的十二指肠溃疡方面是否是一种有效的替代方法，并通过手术技术的标准化鼓励经验较少的外科医生应用该方法。
1984年4月至1996年12月，对206例十二指肠溃疡患者进行了选择性部分胃切除术并采用毕罗Ⅱ式重建。其中，31例（15%）采用了芬斯特勒 - 班克罗夫特方法。患者年龄在23至65岁之间，男性25例，女性6例。所有病例均因存在狭窄而需要手术。
3例患者（9.7%）出现并发症。1例（3.2%）因十二指肠残端漏和腹膜炎死亡，1例十二指肠瘘（3.2%），1例溃疡复发（3.2%）。所有3例并发症均因该方法应用不当所致。
我们得出结论，芬斯特勒 - 班克罗夫特手术在治疗被认为无法切除的慢性十二指肠溃疡时是一种有效的替代方法，并且实习医生和经验较少的外科医生也能够掌握。
