胃十二指肠疾病-08英文-压缩.pptVIP

Surgical Treatment of Gastric and Duodenal Diseases胃十二指肠疾病的外科治疗 南方医科大学第二临床学院 普通外科厉周 Richard Lee leezhou888@ 397718,Medical words 胃: Stomach, gaster-, gastro- 十二指肠：Duodenum 消化性溃疡：Peptic Ulcer 穿孔：Perforation 出血： Hemorrhage, bleeding 幽门狭窄：Pyloric stenosis 胃大部切除术：gastrectomy The stomach resides in the upper abdomen and is dorsally(背侧) bounded(束缚) by the pancreas and retroperitoneum(后腹膜); the ventral(腹侧的) border of the stomach is the anterior abdominal wall and left lobe of the liver. The stomach is anatomically defined at its superior margin by the gastroesophageal junction, which is normally found at the esophageal hiatus(食管裂孔) of the diaphragm, and inferiorly by the pylorus. Anatomy and physiology 胃及十二指肠的解剖生理 The main function of the stomach is to act as a reservoir(贮器) for ingested food. The upper part of the stomach is capable of adaptive relaxation to accommodate(使适应) the food. The antrum(胃窦) acts as a mill(磨坊) and its contractions fullfil two functions. To churn(搅拌) the food into chyme(食糜). To deliver it in graduated amounts into the duodenum. ?2. Surgical treatment of gastric and duodenal ulcer胃十二指肠溃疡的外科治疗 2.1. Etiology and Phathophysiology病因和发病机制 (1)．Increased acid or pepsin secretion 胃酸增高; (2)．Helicobacter pylori 幽门螺杆菌 (3)．Mucosal defence mechanism 胃粘膜屏障损害 (4)．Smoking, alcohol, Non-steroidal anti-inflammatory drugs (NSAIDs)药物作用 2.2. Complications Perforation Haemorrhage Pyloric stenosis Malignancy Iron deficiency anaemia 2.3. Adaptation胃十二指肠溃疡外科治疗的适应症 内科治疗(8-12周)无效或愈后复发 出现大出血、幽门梗阻或溃疡穿孔等并发症(年龄在45岁以上)Perforation, Hemorrhage, Pyloric stenosis 疑恶变之溃疡 Complex ulcer 胃十二指肠复合溃疡 Ｘ线或胃镜证实溃疡较大(2.5cm以上)或高位溃疡(胃底、贲门) 2.3.1. Perforation 胃十二指肠溃疡穿孔 穿孔多发生在病变十二指肠球部前壁及胃小弯侧 (1)．临床表现： ①上腹剧痛 ②出现腹膜炎症状及体征 (2)．诊断要点： ①溃疡病史(少数无溃疡病史) ②近期上腹不适 ③tabulate venter 板状腹, 肝浊音界缩小，肠鸣音 消失，腹式呼吸↓ ④X光平片膈下出现游离气体 ⑤血生化检查，WBC↑、N↑ 早期其他检查可能无阳性发现 tabulate venter (3)．? 治疗： 非手术治疗： ①指征：若有条件诊断后均应手术，空腹穿孔病变部位局限，临床症状轻 ②方法：除加用抗酸剂及抗幽门螺旋杆菌外其他同腹膜炎治疗 手术治疗：除非手术治疗外，一切穿孔病例,其方法有