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| 篇名 |
Management of Difficult Duodenal Stump:VGH-Kaohsiung Experience |
| 作者 |
Po-Min Chang, Shiuh-Inn Liu, King-Tong Mok, Nan-Hua Chou,Cheng-Chung Tsai, Being-Whey Wang, Ming-Hsin Yeh, Yu-Chia Chen, I-Shu Chen |
| 卷期/出版年月 |
38卷5期 (2005/10) |
| 頁次 |
230-237 |
| 摘要 |
Purpose: Although most peptic ulcers are currently treated successfully with
medical treatment, some still need surgical intervention because of the complications
caused by peptic ulcer disease, such as bleeding, perforation and obstruction. Partial
gastrectomy with Billroth II reconstruction is one of the commonly performed procedures.
However, in those patients with a difficult duodenal stump, which is usually
caused by chronic ulcer in the posterior wall of the duodenal bulb, the duodenal
stump leakage rate is high if it is closed by a traditional method. Hence, alternative
methods to the conventional duodenal closure have been reported for the management
of the so-called difficult duodenal stump , including Nissen s closure,
Bancroft s closure and tube duodenostomy, etc. We report our experience in the management
of the difficult duodenal stump and present our modified method of Nissen s
closure.
Methods: A retrospective study was performed in reviewing patients with duodenal
ulcers who underwent partial gastrectomy with Billroth II reconstruction. Patient
profile, incidence of difficult stumps, method for duodenal stump closure, post-operative
morbidity and mortality were collected and analyzed. We modified Nissen s
closure with an interrupted far-near whole layer suture for duodenal stump closure
as an easier method.
Results: From November 1990 to July 2002, 242 patients underwent partial gastrectomy
with Billroth II reconstruction due to complications of duodenal ulcer. The
overall duodenal stump leakage rate was 13.6% (n=33). Eighty-five patients were
considered to have a difficult duodenal stump and had significantly higher leakage,
complication and mortality rates. No stump leakage was noted in either Nissen s or
our modified Nissen s closure.
Conclusions: Gastric resection is usually unavoidable at the management of complications
of duodenal ulcer. Facing the difficult duodenal stump after gastric resection,
especially in chronic and large-sized duodenal ulcers at the posterior wall of the duodenal
bulb, our modified Nissen s closure is a good and safe alternative method for
easy duodenal stump closure. |
| 關鍵詞 |
difficult duodenal stump, duodenal ulcer, partial gastrectomy, Nissen's closure |
| 分類 |
Original Article |
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