Main surgical purposes, methods and postoperative complications of peptic ulcer

Main surgical purposes, methods and postoperative complications

1. Perforation suture

It is mainly suitable for perforation of gastric and duodenal ulcer. Precautions: ① Needle is inserted along the stomach axis and discharged through the whole layer; (2) preventing suture to the contralateral gastric wall; ③ The gastric wall edema at the perforation is obvious, and the tightness should be moderate when tying the knot, so as to avoid cutting the tissue when suturing; ④ The omentum can be covered first, and then the suture can be ligated to prevent the tissue from being cut; ⑤ For those who are suspected of malignant transformation, tissue should be taken from the perforation for pathological examination.

2. subtotal gastrectomy

This is the traditional method. The resection range is: 2/3 of the distal stomach? 3/4。 The anastomosis is generally required to be about 3cm. There are two main types: ① Bi-I subtotal gastrectomy: this operation directly anastomoses the remnant stomach with the duodenum after subtotal gastrectomy; ② Bi Ⅱ subtotal gastrectomy: After subtotal gastrectomy, the remnant stomach is anastomosed with the proximal jejunum and the duodenal stump is sutured, which is suitable for GU and DU.

3. Postoperative complications

(1) Early postoperative complications

1) postoperative bleeding: the normal postoperative bleeding volume is less than 300ml/ 24 hours before, and it is usually only closely observed without diagnosis. If it exceeds this amount of bleeding, or it still bleeds for more than 24 hours, it is diagnosed as postoperative bleeding. If bleeding occurs within 24 hours after operation, multi-system operation is not accurate to stop bleeding; What if it happened four days after the operation? After 6 days, most of the bleeding was due to mucosal necrosis at the anastomotic site; What if it happened after the operation? 20 days, mostly caused by suture infection and vascular corrosion. Most of the bleeding can be stopped by non-surgical treatment, and the massive bleeding that is ineffective by conservative treatment needs to be stopped again.

2) Duodenal stump rupture: The clinical manifestations are similar to acute perforation of ulcer, which requires immediate surgical treatment.

3) Ischemic necrosis of gastrointestinal wall, rupture or leakage of gastrointestinal anastomosis after operation: mostly occurred in 5? After 7 days, symptoms of localized peritoneal irritation suddenly appear, or X-ray abdominal plain film can show free gas under the diaphragm, so the diagnosis can be confirmed. The anastomotic rupture needs immediate surgical repair; The formation of external fistula should be treated by drainage, gastrointestinal decompression and surgery if necessary.

4) postoperative obstruction: ① input segment obstruction: it can be divided into two types. Acute complete input obstruction is an acute closed obstruction, which can cause intestinal necrosis and perforation. The main manifestation is severe pain in the upper abdomen, and the vomit contains no bile, which can be diagnosed and needs surgical treatment. When chronic incomplete input segment obstruction and symptoms can not be relieved for a long time, surgery can be performed. ② Obstruction of anastomotic stoma: Most of them are caused by too small anastomotic stoma, edema or eversion. First of all, gastrointestinal decompression to eliminate edema can usually be alleviated. If the above treatment fails, another operation is needed. ③ Obstruction of output segment: mainly manifested as fullness of upper abdomen and bile in vomit. If it can't be relieved by X-ray barium meal, it should be operated immediately.

5) Postoperative gastroparesis: it is a common complication after gastric surgery and other abdominal operations, mainly the syndrome of gastric emptying disorder. The main manifestation is that when the patient starts to input liquid or semi-liquid, the patient appears nausea and vomiting, and the vomit is mostly green. If the liquid is not replenished and adjusted in time for a long time, it is prone to water, electrolyte, acid-base disorder and nutritional disorder. Early treatment is mainly gastric tube decompression and intravenous rehydration, and adjuvant drugs are intravenous metoclopramide and erythromycin, which are not suitable for surgery in principle. The recovery time is long.

(2) Long-term postoperative complications

Dumping syndrome: it can be divided into early dumping syndrome and late dumping syndrome, both of which belong to the loss of pyloric control function after subtotal gastrectomy, leading to a series of clinical symptoms, which are more common after Bi ⅱ operation.

Early dumping syndrome: because hypertonic food enters jejunum too quickly, a large number of secretory cells in the intestine secrete vasoactive substances.

Quality, a large number of extracellular fluid is sucked into the intestinal cavity, resulting in a sudden decrease in circulating blood volume, which is characterized by palpitation, nausea, vomiting, fatigue, cold sweat, pale face and diarrhea. Treatment should eat less and eat more meals, avoid too sweet and hypertonic food, can be treated with somatostatin, and the operation should be cautious.

Late dumping syndrome: eat 2? A large amount of food enters the intestine within 4 hours, leading to increased insulin secretion and reactive hypoglycemia. Treatment should adopt diet adjustment to slow down carbohydrate absorption, and somatostatin can be used if necessary.

2) Alkaline reflux gastritis: leads to mucosal congestion, edema and erosion, which is characterized by persistent burning pain under xiphoid process, bile vomiting and weight loss. Comprehensive treatments such as protecting gastric mucosa and regulating gastric motility are often used.

3) Anastomotic ulcer: It often occurs within 2 years after operation, with similar symptoms to the original ulcer, severe pain and easy bleeding. First of all, regular non-surgical treatment of ulcers should be carried out.

4) Nutritional complications: ① Insufficient nutrition and weight loss: We should adjust the diet, eat less and eat more meals, choose a high-protein and low-fat diet, and supplement vitamins according to the cause. ② Anemia: Subtotal gastrectomy reduced the secretion of parietal cells, hydrochloric acid and endogenous factors. Insufficient stomach acid can cause iron deficiency anemia, which can be treated with iron. The deficiency of endogenous factors can cause megaloblastic anemia, and vitamin B 12 can be given.

Folic acid and other treatments, severe cases can be given blood transfusion. ③ Diarrhea and fatty diarrhea: It is called fatty diarrhea when the fat discharged from feces exceeds 7% of the intake. You can eat a high-protein diet with little residue and easy digestion, and use cholestyramine and antibiotics. ④ Osteopathy: mostly occurred after operation? 10 years is more common in women, which can be divided into recessive osteomalacia, osteoporosis and mixed type, and calcium and vitamin D can be supplemented.

5) Gastric stump cancer: refers to the primary cancer that occurred in gastric stump cancer due to benign lesions at least 5 years after subtotal gastrectomy and needs to be re-operated for radical resection. The most common occurrence is 10 years after operation.