摘要
十二指肠残端瘘是胃手术后最为严重的并发症,有较高的发生率和病死率。术中十二指肠残端的正确处理是预防十二指肠残端瘘的关键,尤其对于胃十二指肠溃疡急性穿孔致肠壁水肿严重或大出血、巨大溃疡瘢痕等困难残端的处理上,术式的选择及术中精细操作显得尤为重要。如术后发现十二指肠残端瘘,需结合具体情况如发生的急缓、病人一般状态、十二指肠残端引流情况、腹部体征等,决定保守治疗或是二次手术治疗。针对不同病因施行胃部手术,首次手术处理十二指肠残端选择最恰当的方式,发生十二指肠残端瘘后及时诊断并给予正确的处理,可降低其病死率,改善病人生活质量及预后。
The duodenal stump leakage with high mortality and morbidity is the most devastating complication after gastrectomy. The key to prevent the duodenal stump out-breaking is to choose the right operation procedure for the stump, especially to the difficult duodenal stumps occurring in acute perforation of gastroduodenal ulcer, edema or serious hemorrhage and tremendous ulcer scar. The outcomes mostly depend on the choice of procedure and accurate manipulation. If the duodenal stump leakage occurs after gastrectomy, it needs to be decided which management the patient should accept conservation treatment or reoperation, according to whether the leakage is acute or not, patients＇ general status, drainage of the leakage and symptom and physical sign, etc. The proper initial procedure for different gastroduodenal pathological changes, faultless surgical skills, prompt diagnosis and suitable management can reduce the mortality and morbidity of the duodenal stump leakage, and improve the quality of life and prognosis of the patients performed gastrectomy.
出处
《中国实用外科杂志》
CSCD
北大核心
2013年第4期286-289,共4页
Chinese Journal of Practical Surgery
