Chronic Corrosive Injuries of the Stomach-A Single Unit Experience of 109 Patients Over Thirty Years
Chronic Corrosive Injuries of the Stomach-A Single Unit Experience of 109 Patients Over Thirty Years
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DOI：
10.1007/s00268-010-0393-8
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发表时间：
2010-04-01
影响因子：
2.6
通讯作者：
Kate, Vikram
中科院分区：
文献类型：
--
作者：
Ananthakrishnan, N.;Parthasarathy, G.;Kate, Vikram
腐蚀性胃损伤在发展中国家并不少见，因为酸是主要的有害化学物质，酸更常与胃损伤有关。胃损伤的范围从急性到不同类型的慢性胃损伤可能不同。我们回顾了30年来在一家三级保健专科机构连续收治的109例慢性腐蚀性胃损伤患者的临床表现和处理问题。慢性胃损伤通常是这些患者的五种类型之一。大多数患者有幽门前狭窄(83.5%)。其余狭窄为胃窦(4.6%)、体部(3.7%)、幽门十二指肠(2.7%)或弥漫性狭窄(5.5%)。21例(22.8%)患者出现延迟性胃出口梗阻，18例合并食道狭窄需要转流。大部分慢性损伤患者行Billroth I式胃切除(77.1%)、胃空肠环形吻合术(11.0%)、远端胃切除Polya重建术(3.7%)。幽门成形术1例，结肠管空肠吻合术6例。1例(1%)在术后死亡。慢性腐蚀性胃损伤的治疗取决于胃部受累的类型、共存的食道狭窄的存在以及患者的一般情况。有限切除受影响的胃是治疗常见类型胃损伤的理想手术方式。在一般情况下不能进行大范围切除或狭窄延伸至胃窦的患者，最好的治疗方法是胃肠环形吻合术。III型、IV型、V型狭窄需要个体化治疗。延迟性胃出口梗阻影响胃、食道联合损伤的治疗方案。
Corrosive gastric injuries are not uncommon in developing countries because acids, which are more frequently associated with gastric injury, constitute the major type of offending chemical. The spectrum of gastric injury may vary from acute to varying types of chronic gastric involvement.The 109 consecutive patients with chronic corrosive gastric injuries treated in a single tertiary care superspecialty institute over a period of 30 years were reviewed with special reference to presentation and problems in management.Acids contributed to 82.6% of chronic injuries. Chronic gastric injuries were usually one of five types in these patients. The majority had prepyloric strictures (83.5%). The remaining strictures were antral (4.6%), body (3.7%), pyloroduodenal (2.7%), or diffuse (5.5%).Twenty-one (22.8%) patients had a delayed gastric outlet obstruction, and18 patients had a concomitant esophageal stricture requiring a bypass. Most of the patients with chronic injury underwent surgical correction with Billroth I gastrectomy (77.1%), loop gastrojejunostomy (11.0%), and distal gastrectomy with Polya reconstruction (3.7%). Other procedures performed were pyloroplasty in 1 patient and colonic conduit jejunal anastomosis in 6 patients. One patient (1%) died in the postoperative period.The management of chronic corrosive gastric injury depends on the type of gastric involvement, the presence of co-existent esophageal stricture, and the general condition of the patient. A limited resection of the affected stomach is the ideal procedure for the common type of gastric injury. In patients whose general condition prohibits major resection or where the stricture extends to the antrum the best treatment is a loop gastroenterostomy. Type III, IV, V strictures require individualized treatment. Delayed gastric outlet obstruction affects the treatment plan of combined gastric and esophageal injuries.