Nissen法联合负压封闭引流治疗十二指肠球后溃疡术后残端瘘的临床研究  

Clinical research of Nissen method combined with vacuum sealing drainage for treatment of residual fistula after duodenal retro-bulbar ulcer operation

作　　者：庄志浩[1] 欧阳秋伟 陶世明[1] 霍景山[1] 吴岷翰[1] 韩新峰[1] 贺友 Zhuang Zhihao;Ouyang Qiuwei;Tao Shiming;Huo Jingshan;Wu Minhan;Han Xinfeng;He You(Department 1 of Surgery,Foshan Hapilal of Trudional Chinese Medicine,Foshan 528000,Guangdong,China)

机构地区：[1]佛山市中医院外一科,广东佛山528000

出　　处：《中国中西医结合急救杂志》2020年第5期592-594,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广东省佛山市科技计划项目(2015AB00345)。

摘　　要：目的 探讨Nissen法联合负压封闭引流(VSD)治疗十二指肠球后溃疡术后残端瘘的临床疗效.方法 回顾性分析佛山市中医院2010年1月至2019年12月收治的10例十二指肠球部后壁溃疡并出血患者的临床资料.术中采用Nissen法处理十二指肠残端,在距离十二指肠残端1cm处留置切口行-100mmHg(1mmHg≈0.133kPa)VSD.胃大部分切除术后于结肠前行BillrothⅡ式胃空肠吻合术.术后约2周拔除引流海棉.围手术期加强抗感染、抑酸抑酶及营养支持等治疗.结果 所有患者均行急诊剖腹探查,术中可见溃疡面积约1-16cm2,术中出血量100-900mL,术中输注红细胞悬液2U4例、4U2例,未给予输血4例,手术时间90-240min.术后3例转入重症监护病房(ICU)治疗,7例转入普通病房.术后发生十二指肠残瘘1例,维持引流,15d后痊愈拔除引流海绵;发生肺部感染、切口感染各1例,并发症发生率为20%.术后住院时间7-19d,围手术期无患者进行二次手术,也无死亡病例.出院后定期门诊及电话随访,无再发腹痛、呕血、黑便等情况.结论 采用Nissen法联合VSD能预防和治疗十二指肠球后溃疡残端瘘,值得临床推广应用.Objective To investigale the clinical eleet of Nissen method combined with vacuurm sealing drainage(VSD)for treatment of residual fistula after duodenal retro-bulbar ulcer operation.Methods The clinical data of 10 patients with duodenal bulbar posterior wall ulcer and bleeding admitted and treated in Foshan Hospital of Traditional Chinese Medicine from January 2010 to December 2019 were retrospectively analyzed.During the operation,Nissen method was used to treat the duodenal stump,and an incision was placed 1 cm away from the duodenal stump for retention of VSD-100 mmHg(1 mmHg≈0.133 kPa).After subtotal gastretomy,the gastrointestinal anastomosis was performed by colon forward moving Billroth type colostomy.After operation for about 2 weeks,the drainage spongy was pulled out.During the peri-operative period,the anti-infection,acid inhibition,enzyme inhibition therapies,nutitional support,etc.should be strengthened.Results All patients underwent emergency laparotomy,the ulcer area was about 1-16 cm^2,the bleeding volume was 100-900 mL,the red hlood cell suspension was infused with 2 unit in 4 cases,4 unit in 2 cases,no blod transfusion in 4 cases,and the operation time was 90-240 minutes.After operation,3 cases were transferred to intensive care unit(ICU),and 7 cases to general ward.After operaticn,one case with duodenal residual fistula maintaining drainage for 15 days was cured and then the drainage sponge was pulled oul,one cease of pulmonary infection and one case of incision infection occurred and treated respectively.the incidence of complications being 20%The postoperative hospital stay was 7-19 days.and there were no rases undergoing secondary operation or dead during the peri-operative period.After discharge,regular time outpatient service and telephone follow-up were carried out,and no recurrences of abdominal pain,hematemesis,black stool,ete.were seen.Conclusion Nissen method combined with vacuum sealing drainage can prevent and treat stump fistula after operation of duodenal retro-bulbar uleer,being

关 键 词：十二指肠球后溃疡 Nissen法 负压封闭引流 残端瘘 

分 类 号：R47[医药卫生—护理学]