The surgical management of complicated peptic ulcer disease: An EAST video presentation.
The surgical management of complicated peptic ulcer disease: An EAST video presentation.
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DOI：
10.1097/ta.0000000000003636
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发表时间：
2022-07-01
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消化性溃疡病（PUD），曾经是一个主要的外科问题，现在在大多数患者中进行医学管理。PUD的手术治疗现在严格保留用于危及生命的并发症。虽然在PUD的医学管理时代很少发生自由穿孔、难治性出血和胃出口梗阻，但它们是手术干预的几个适应症。PUD患者的急诊外科医生应熟悉出血控制、消化道狭窄旁路、迷走神经切断术及切除和重建等技术。本视频程序和技术文件演示了这些不常遇到的，但关键的操作。结合解剖表示和视频的一步一步的说明灌注尸体将证明在以下关键操作的关键步骤。格雷厄姆补片修补穿孔的消化性溃疡是证明在开放和腹腔镜的方式。选择开放手术还是腹腔镜手术取决于外科医生的舒适度。在先进的内窥镜检查和介入放射学技术时代，通过十二指肠切开术和胃十二指肠动脉结扎缝合出血的十二指肠溃疡并不常见，但这种曾经熟悉的手术可以挽救生命。巨大十二指肠溃疡或胃溃疡的修复术在如何最好地修复或排除缺损方面存在挑战性的手术困境。迷走神经切断术和胃窦切除术，可能是所有上述手术干预中最不常见的，可能需要比其他技术更复杂的重建，这对没有经验的外科医生来说是一个挑战。将显示重建选项的简要演示，包括Roux-en-Y胃空肠吻合术。PUD的外科治疗今天被保留用于危及生命的并发症，急诊外科医生必须为此做好准备。本报告提供了出血和自由穿孔的管理，以及胃切除术，迷走神经切断术和重建的关键外科原则的示范。视频程序和技术不适用
Peptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved for life-threatening complications. Free perforation, refractory bleeding and gastric outlet obstruction, although rare in the age of medical management of PUD, are several of the indications for surgical intervention. The acute care surgeon caring for patients with PUD should be facile in techniques required for bleeding control, bypass of peptic strictures, and vagotomy with resection and reconstruction. This video procedures and techniques paper demonstrates these infrequently encountered, but critical operations. A combination of anatomic representations and videos of step-by-step instructions on perfused cadavers will demonstrate the key steps in the following critical operations. Graham patch repair of perforated peptic ulcer is demonstrated in both open and laparoscopic fashion. The choice to perform open versus laparoscopic repair is based on individual surgeon comfort. Oversewing of a bleeding duodenal ulcer via duodenotomy and ligation of the gastroduodenal artery is infrequent in the age of advanced endoscopy and interventional radiology techniques, yet this once familiar procedure can be lifesaving. Repair of giant duodenal or gastric ulcers can present a challenging operative dilemma on how to best repair or exclude the defect. Vagotomy and antrectomy, perhaps the least common of all the aforementioned surgical interventions, may require more complex reconstruction than other techniques making it challenging for inexperienced surgeons. A brief demonstration on reconstruction options will be shown and includes Roux-en-Y gastrojejunostomy. Surgical management of PUD is reserved today for life-threatening complications for which the acute care surgeon must be prepared. This presentation provides demonstration of key surgical principles in management of bleeding and free perforation as well as gastric resection, vagotomy and reconstruction. Video Procedure and Technique Not applicable