穿孔性胃潰瘍的管理:一篇評論
Seyed A Arshad1, Patrick Murphy2, Jon C Gould1
1Division of Minimally Invasive and Gastrointestinal Surgery, Medical College of Wisconsin, Milwaukee.
JAMA surgery
|February 12, 2025
概括
穿孔性胃潰瘍疾病 (PUD) 的管理,包括未成功的修復,因患病率和死亡率高,仍然具有挑戰性. 最少侵入性手术是PUD穿孔的首选方法.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
背景情况:
- 穿孔性胃潰瘍疾病 (PUD) 影響全球數百萬人,具有顯著的終身流行率和進行到穿孔.
- 尽管治疗进展,穿孔PUD保持高发病率 (48.5%) 和死亡率 (9.3%).
研究的目的:
- 审查当前关于管理穿孔PUD的证据.
- 讨论解决失败的外科修复和反复泄漏的策略.
主要方法:
- 对目前关于穿孔PUD管理的证据的文献综述.
- 对手术修复技术的分析,包括初级关闭和指甲贴片.
- 评估处理维修后泄漏的方法.
主要成果:
- 最少侵入性手术显示出比穿孔PUD的开放技术更好的结果.
- 关闭口腔贴片可能有利于具有易碎组织的大型穿孔.
- 修复后泄漏发生在12-17%的病例中,与高发病率和死亡率有关.
结论:
- 穿孔PUD需要谨慎管理,因为持续的高发病率和死亡率.
- 微创手术是目前对穿孔PUD的首选治疗方法.
- 修复后泄漏的管理需要迅速干预,经常需要重复手术.
相关概念视频
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