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患者男,42岁.间断黑便4个月,无黄疸、返酸、呕吐.多次胃镜检查示:十二指肠球溃疡,降部后壁(1.5×1.0cm)溃疡,活动出血.病理为炎症.内科治疗3个月无效.于1988年8月转外科手术治疗.手术发现,十二指肠球部短缩,瘢痕变形.水肿严重.周围粘连,遂行毕Ⅱ式胃次全切除手术;结肠后胃空肠吻合术.术后间断呕鲜血.黑便.经胃镜检查输入袢有鲜血溢出.营养状况差.全身坠积性水肿.再次手术探查.发现总胆管下端开口处(即乳头)可见一肿物.似有界限,直径2.5cm大小,呈新月型围绕乳头并凸入肠腔内,中心凹陷溃疡.并有活动性出血,基底固定,区域内淋巴结来见明显肿大.术者认为肿瘤的可能性大,如行胰十二指肠切除术难以耐受.故决定行肿物局部切除,手术方法:自总胆管中段插入—橡胶管至乳头,沿肿物边缘及橡胶管将肿物完整切除,残留粘膜缝合,于胆总管内置放“T”管一根,并行高位空肠造瘘.术后仅静脉规范高营养12天,胃肠道高营养15天,病愈出院.
Male patient, 42 years old. 4 months of intermittent melena, no jaundice, acid reflux, vomiting. Repeated gastroscopy showed: duodenal ulcer, descending posterior wall (1.5 × 1.0cm) ulcer, active bleeding. Pathology Inflammation. Medical treatment was ineffective for 3 months. Surgical treatment was transferred in August 1988. The operation revealed that the duodenal bulb shortened, the scar was deformed, and the edema was severe. Peripheral adhesions were performed and the operation was performed by subtotal gastrectomy. Postcolon jejunojejunostomy. Postoperative cessation of vomiting of blood. Black stools. Enteroscopy through the endoscopy with blood spillage. Poor nutritional status. Systemic hypophyseal edema. Reexploratory surgery. Find the opening of the lower end of the common bile duct (ie, the nipple) Obviously, there is a borderline, 2.5cm in diameter. It is crescent-shaped around the nipple and protrudes into the lumen of the intestine. The center is hollowed with ulcers. There is active bleeding, and the basement is fixed. The lymph nodes in the area show obvious enlargement. The author believes that the possibility of tumor is large, such as pancreatoduodenectomy is difficult to tolerate. It was decided to carry out local tumor resection, surgical methods: from the middle of the common bile duct - rubber tube to the nipple, along the edge of the tumor and the rubber tube The tumor was completely resected and the residual mucosa was sutured. A “T” tube was placed inside the common bile duct. Bit jejunostomy. Intravenous specification only after 12 days of high nutrition, parenteral nutrition high 15 days, recovered and discharged.