CAJ | 학술논문

目的探讨非手术治疗后十二指肠溃疡穿孔(PDU)闭合早期的溃疡形态变化及临床意义.方法选择胃十二指肠穿孔的非手术治疗患者302例,在住院期间达到穿孔闭合的临床指标后,通过早期胃镜观察穿孔病因为十二指肠溃疡(DU)的病灶形态变化.结果确诊穿孔病因为DU 255例,胃镜下病灶形态除1例合并肠瘘外,均表现为特征性底部封闭的深凹陷溃疡,溃疡类型也随着治疗后与胃镜检查间隔时间的不同而变化.本组病例均无因胃镜检查而出现溃疡再穿孔或再现腹膜炎.结论以A1期为主的深凹陷溃疡是PDU非手术闭合后早期的特征性病理改变,而浆膜侧肠壁的封闭是溃疡穿孔闭合的最初形式.DU的穿孔高危性与下列因素相关:(1)位于球部前壁区域的单发DU.(2)对吻型多发DU.(3)溃疡直径≥1.1 cm.非手术治疗达标后的早期胃镜检查是此类穿孔病因确诊的安全途径.
목적 탐토비수술치료후십이지장궤양천공(PDU)폐합조기적궤양형태변화급림상의의.방법 선택위십이지장천공적비수술치료환자302례,재주원기간체도천공폐합적림상지표후,통과조기위경관찰천공병인위십이지장궤양(DU)적병조형태변화.결과 학진천공병인위DU 255례,위경하병조형태제1례합병장루외,균표현위특정성저부봉폐적심요함궤양,궤양류형야수착치료후여위경검사간격시간적불동이변화.본조병례균무인위경검사이출현궤양재천공혹재현복막염.결론 이A1기위주적심요함궤양시PDU비수술폐합후조기적특정성병리개변,이장막측장벽적봉폐시궤양천공폐합적최초형식.DU적천공고위성여하렬인소상관:(1)위우구부전벽구역적단발DU.(2)대문형다발DU.(3)궤양직경≥1.1 cm.비수술치료체표후적조기위경검사시차류천공병인학진적안전도경.
Objective To research early pathological morphology and clinical significance of perforated duodenal ulcer (PDU) closed after non-surgical treatment. Methods Observed morphological changes of duodenal ulcer (DU) lesion with gastroscopy for 302 patients of PDU with non-surgical treatment in early period,when the perforation closed and measured up the clinical indicators during this hospitalization.Results There were 255 patients to be diagnosed with DU caused the perforation. These lesions were characteristic and shown the PDU closed at the bottom and the deep concave ulcers, except for 1 case which complicated by duodenal fistula. These ulcer types were diverse according to the time difference after treatment. No case of re-perforated ulcers or recurrence of peritonitis caused by gastroscopy. Conclusions Deep concave ulcer with A1 phase mainly is an early pathological manifestations of the DU after treated the PDU with non-surgical method characteristically. The wall of the closure of the serosal side is an original form closed perforated ulcer by non-surgical treatment. The risk of perforation associated with the following factors:( 1 )A single DU is located in the anterior wall region. (2)The shape of two kissing DU. (3)The diameter of DU ≥ 1.1 cm. In this case,early diagnosis by using endoscopy is a safe way.