胃穿透性潰瘍侵蝕胰腺及脾臟血管： 1例報道及文獻復習_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

李依宸 ¹ , 譚春路 ¹ , 陳擁華 ¹ , 劉續寶 ¹ ,  易智慧 ²

1. ;
2. ;

Corresponding?author：

易智慧, Email: yzh616@163.com

Keywords：

消化性潰瘍; 穿透性潰瘍; 手術治療

DOI：

10.7507/1007-9424.202308018

Video：

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目的總結胃穿透性潰瘍侵蝕胰腺及脾臟血管患者的診治經驗，為臨床診治提供一定的參考。方法回顧四川大學華西醫院收治的1例胃穿透性潰瘍侵蝕胰腺及脾臟血管患者的病程發展、診治過程及臨床結局，并結合在中英文數據庫中檢索到的相關病例進行討論，對本病臨床特征、治療措施、臨床結局等進行總結。結果本例患者行近端胃切除術、脾切除術及胰腺修補術，術后檢查及隨訪結果提示患者痊愈。共檢索到27篇相關病例的文獻報道，包括本例患者在內共30例患者，其中男21例、女9例，發病年齡為（56.7±13.2）歲，臨床癥狀以上腹部疼痛為主（66.7%），潰瘍好發于胃小彎（26.7%）及胃后壁（23.3%），穿透性潰瘍最大直徑為（4.2±2.4）cm，易受侵犯部位包括胰腺（40.0%）、脾臟血管（33.3%）、肝臟（33.3%），治療方案以胃部分切除術為主（27.2%），受潰瘍侵蝕組織器官多采取局部修補手術治療（68.2%）。結論胃穿透性潰瘍為消化性潰瘍少見并發癥，患者應行消化內鏡及腹部CT評估潰瘍進展情況。若已經發生潰瘍穿透，則應積極開展手術治療并及時處理病灶，避免穿透進一步侵蝕周圍器官及重要血管。

Citation： 李依宸, 譚春路, 陳擁華, 劉續寶, 易智慧. 胃穿透性潰瘍侵蝕胰腺及脾臟血管： 1例報道及文獻復習. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(12): 1483-1487. doi: 10.7507/1007-9424.202308018 Copy

1.	Stylianopoulou L, Bartsokas C, Kalliakmanis V. Gastric ulcer penetration into liver: a case presentation and review of the literature. Clin Case Rep, 2020, 9(1): 282-285.
2.	Dhruv S, Gurala D, Philipose J, et al. Gastropancreatic fistula: a rare complication of peptic ulcer disease. ACG Case Rep J, 2021, 8(7): e00622. doi: 10.14309/crj.0000000000000622.
3.	Shibukawa N, Ouchi S, Wakamatsu S, et al. A rare case of gastric ulcer penetrating the pancreas that was successfully managed by conservative therapy. Intern Med, 2017, 56(17): 2277-2279.
4.	Sawicki M, Marlicz W, Czapla N, et al. Massive upper gastrointestinal bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer: case report and review of literature. Pol J Radiol, 2015, 80: 384-387.
5.	Judd S, Vanama R, Levi E, et al. Splenic abscess: a rare adverse event of a benign penetrating gastric ulcer. Gastrointest Endosc, 2015, 82(1): 174-175.
6.	Fujihara S, Mori H, Nishiyama N, et al. Giant gastric ulcer penetrating into the pancreas. Arab J Gastroenterol, 2012, 13(3): 158-160.
7.	Pasumarthy L, Kumar RR, Srour J, et al. Penetration of gastric ulcer into the splenic artery: a rare complication. Gastroenterology Res, 2009, 2(6): 350-352.
8.	李丹, 宋志芳. 以胸痛為主訴的胃穿透性潰瘍并腹腔膿腫1例報道. 胃腸病學和肝病學雜志, 2008, 17(5): 389, 393.
9.	Kayacetin E, Kayacetin S. Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy. World J Gastroenterol, 2004, 10(12): 1838-1840.
10.	唐子東, 王芳. 胃底部穿透性潰瘍并巨大假憩室誤診1例. 罕少疾病雜志, 2002, 9(5): 41-41.
11.	劉鴻章, 薛琪彪. 胃竇部后壁穿透性潰瘍并胃十二指腸瘺1例. 實用醫學雜志, 2001, 17(5): 444.
12.	陳志新, 胡建昆, 何生, 等. 胃穿透性潰瘍侵蝕脾靜脈致失血性休克1例報告. 中國普外基礎與臨床雜志, 2001, 8(4): 214.
13.	孫贛清, 陳雪峰, 張文軍, 等. 胃體后壁大彎側巨大穿透性潰瘍1例報告. 現代醫用影像學, 2000, 9(2): 72.
14.	Zanotti M, Amboldi A, Musazzi M, et al. Giant benign gastric ulcer penetrating into the liver, pancreas and mesocolon. Minerva Chir, 1999, 54(6): 415-419.
15.	Lavery M, Kyle J. Pancreatico-gastric fistula due to giant gastric ulcer. Br Med J, 1959, 1(5123): 697. doi: 10.1136/bmj.1.5123.697.
16.	楊貴龍, 馬宏波, 鄒德齡. 胃角部潰瘍穿孔并竇部后壁穿透性巨大潰瘍1例. 黑龍江醫學, 1999, 176(2): 84.
17.	來永德, 祁靜, 陸惠良. 胃角慢性巨大穿透性潰瘍一例. 上海醫學, 1997, 20(5): F003.
18.	Joffe N, Antonioli DA. Penetration into spleen by benign gastric ulcers. Clin Radiol, 1981, 32(2): 177-181.
19.	Hughes JJ, Blunck CE. CT demonstration of gastropancreatic fistula due to penetrating gastric ulcer. J Comput Assist Tomogr, 1987, 11(4): 709-711.
20.	Westerveld BD, Hoitsma HWF, van Velzen D et al. Unusual confined perforation of a giant stomach ulcer into the liver with formation of a stomach tissue bridge. Acta Endosc, 1983, 13: 29-32.
21.	Jiménez-Pérez FJ, Mu?oz-Navas MA. Endoscopic diagnosis of gastric peptic ulcer penetrating into the liver. Endoscopy, 1991, 23(2): 98-99.
22.	Fukuda S, Gakuhara A, Ishikawa H, et al. Acute peritonitis caused by gastric insufflation at endoscopy in gastric ulcer penetration into giant cyst of the left hepatic lobe. Oxf Med Case Reports, 2020, 2020(10): omaa091. doi: 10.1093/omcr/omaa091.
23.	韋士康. 胃后壁巨大穿透性潰瘍1例報告. 臨床外科雜志, 1994, 2(6): 317.
24.	Bartsokas C, Voulgaris S, Economopoulos N, et al. Giant gastric ulcer penetrating the pancreas in a haemodynamically unstable patient. BMJ Case Rep, 2022, 15(5): e250527. doi: 10.1136/bcr-2022-250527.
25.	Okumura T, Kimura T, Nakajima D, et al. Splenic artery pseudoaneurysm resulting from gastric ulcer presenting acute upper gastrointestinal bleeding. Radiol Case Rep, 2022, 18(1): 97-99.
26.	Fu KI, Fukui H, Tominaga K, et al. Gastric ulcer penetrating into the heart. Endoscopy, 2006: 38 Suppl 2: E14. doi: 10.1055/s-2006-944631.
27.	Kypraios D, Fusaroli P, Artuso S, et al. Gastric ulcer penetration into the liver mimicking malignancy on endoscopic ultrasound. Endosc Ultrasound, 2013, 2(2): 107-108.
28.	Sverdén E, Agréus L, Dunn JM, et al. Peptic ulcer disease. BMJ, 2019, 367: l5495. doi: 10.1136/bmj.l5495.
29.	Gurusamy KS, Pallari E. Medical versus surgical treatment for refractory or recurrent peptic ulcer. Cochrane Database Syst Rev, 2016, 3(3): CD011523. doi: 10.1002/14651858.CD011523.pub2.
30.	Goldstein JL, Johanson JF, Hawkey CJ, et al. Clinical trial: healing of NSAID-associated gastric ulcers in patients continuing NSAID therapy—a randomized study comparing ranitidine with esomeprazole. Aliment Pharmacol Ther, 2007, 26(8): 1101-1111.
31.	Borao Laguna C, Lanas A. Advances in the pharmacotherapeutic management of refractory peptic ulcers. Expert Opin Pharmacother, 2023, 24(7): 825-833.
32.	Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht Ⅵ/Florence consensus report. Gut, 2022, gutjnl-2022-327745. doi: 10.1136/gutjnl-2022-327745.
33.	Kim HU. Diagnostic and treatment approaches for refractory peptic ulcers. Clin Endosc, 2015, 48(4): 285-290.

1. Stylianopoulou L, Bartsokas C, Kalliakmanis V. Gastric ulcer penetration into liver: a case presentation and review of the literature. Clin Case Rep, 2020, 9(1): 282-285.
2. Dhruv S, Gurala D, Philipose J, et al. Gastropancreatic fistula: a rare complication of peptic ulcer disease. ACG Case Rep J, 2021, 8(7): e00622. doi: 10.14309/crj.0000000000000622.
3. Shibukawa N, Ouchi S, Wakamatsu S, et al. A rare case of gastric ulcer penetrating the pancreas that was successfully managed by conservative therapy. Intern Med, 2017, 56(17): 2277-2279.
4. Sawicki M, Marlicz W, Czapla N, et al. Massive upper gastrointestinal bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer: case report and review of literature. Pol J Radiol, 2015, 80: 384-387.
5. Judd S, Vanama R, Levi E, et al. Splenic abscess: a rare adverse event of a benign penetrating gastric ulcer. Gastrointest Endosc, 2015, 82(1): 174-175.
6. Fujihara S, Mori H, Nishiyama N, et al. Giant gastric ulcer penetrating into the pancreas. Arab J Gastroenterol, 2012, 13(3): 158-160.
7. Pasumarthy L, Kumar RR, Srour J, et al. Penetration of gastric ulcer into the splenic artery: a rare complication. Gastroenterology Res, 2009, 2(6): 350-352.
8. 李丹, 宋志芳. 以胸痛為主訴的胃穿透性潰瘍并腹腔膿腫1例報道. 胃腸病學和肝病學雜志, 2008, 17(5): 389, 393.
9. Kayacetin E, Kayacetin S. Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy. World J Gastroenterol, 2004, 10(12): 1838-1840.
10. 唐子東, 王芳. 胃底部穿透性潰瘍并巨大假憩室誤診1例. 罕少疾病雜志, 2002, 9(5): 41-41.
11. 劉鴻章, 薛琪彪. 胃竇部后壁穿透性潰瘍并胃十二指腸瘺1例. 實用醫學雜志, 2001, 17(5): 444.
12. 陳志新, 胡建昆, 何生, 等. 胃穿透性潰瘍侵蝕脾靜脈致失血性休克1例報告. 中國普外基礎與臨床雜志, 2001, 8(4): 214.
13. 孫贛清, 陳雪峰, 張文軍, 等. 胃體后壁大彎側巨大穿透性潰瘍1例報告. 現代醫用影像學, 2000, 9(2): 72.
14. Zanotti M, Amboldi A, Musazzi M, et al. Giant benign gastric ulcer penetrating into the liver, pancreas and mesocolon. Minerva Chir, 1999, 54(6): 415-419.
15. Lavery M, Kyle J. Pancreatico-gastric fistula due to giant gastric ulcer. Br Med J, 1959, 1(5123): 697. doi: 10.1136/bmj.1.5123.697.
16. 楊貴龍, 馬宏波, 鄒德齡. 胃角部潰瘍穿孔并竇部后壁穿透性巨大潰瘍1例. 黑龍江醫學, 1999, 176(2): 84.
17. 來永德, 祁靜, 陸惠良. 胃角慢性巨大穿透性潰瘍一例. 上海醫學, 1997, 20(5): F003.
18. Joffe N, Antonioli DA. Penetration into spleen by benign gastric ulcers. Clin Radiol, 1981, 32(2): 177-181.
19. Hughes JJ, Blunck CE. CT demonstration of gastropancreatic fistula due to penetrating gastric ulcer. J Comput Assist Tomogr, 1987, 11(4): 709-711.
20. Westerveld BD, Hoitsma HWF, van Velzen D et al. Unusual confined perforation of a giant stomach ulcer into the liver with formation of a stomach tissue bridge. Acta Endosc, 1983, 13: 29-32.
21. Jiménez-Pérez FJ, Mu?oz-Navas MA. Endoscopic diagnosis of gastric peptic ulcer penetrating into the liver. Endoscopy, 1991, 23(2): 98-99.
22. Fukuda S, Gakuhara A, Ishikawa H, et al. Acute peritonitis caused by gastric insufflation at endoscopy in gastric ulcer penetration into giant cyst of the left hepatic lobe. Oxf Med Case Reports, 2020, 2020(10): omaa091. doi: 10.1093/omcr/omaa091.
23. 韋士康. 胃后壁巨大穿透性潰瘍1例報告. 臨床外科雜志, 1994, 2(6): 317.
24. Bartsokas C, Voulgaris S, Economopoulos N, et al. Giant gastric ulcer penetrating the pancreas in a haemodynamically unstable patient. BMJ Case Rep, 2022, 15(5): e250527. doi: 10.1136/bcr-2022-250527.
25. Okumura T, Kimura T, Nakajima D, et al. Splenic artery pseudoaneurysm resulting from gastric ulcer presenting acute upper gastrointestinal bleeding. Radiol Case Rep, 2022, 18(1): 97-99.
26. Fu KI, Fukui H, Tominaga K, et al. Gastric ulcer penetrating into the heart. Endoscopy, 2006: 38 Suppl 2: E14. doi: 10.1055/s-2006-944631.
27. Kypraios D, Fusaroli P, Artuso S, et al. Gastric ulcer penetration into the liver mimicking malignancy on endoscopic ultrasound. Endosc Ultrasound, 2013, 2(2): 107-108.
28. Sverdén E, Agréus L, Dunn JM, et al. Peptic ulcer disease. BMJ, 2019, 367: l5495. doi: 10.1136/bmj.l5495.
29. Gurusamy KS, Pallari E. Medical versus surgical treatment for refractory or recurrent peptic ulcer. Cochrane Database Syst Rev, 2016, 3(3): CD011523. doi: 10.1002/14651858.CD011523.pub2.
30. Goldstein JL, Johanson JF, Hawkey CJ, et al. Clinical trial: healing of NSAID-associated gastric ulcers in patients continuing NSAID therapy—a randomized study comparing ranitidine with esomeprazole. Aliment Pharmacol Ther, 2007, 26(8): 1101-1111.
31. Borao Laguna C, Lanas A. Advances in the pharmacotherapeutic management of refractory peptic ulcers. Expert Opin Pharmacother, 2023, 24(7): 825-833.
32. Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht Ⅵ/Florence consensus report. Gut, 2022, gutjnl-2022-327745. doi: 10.1136/gutjnl-2022-327745.
33. Kim HU. Diagnostic and treatment approaches for refractory peptic ulcers. Clin Endosc, 2015, 48(4): 285-290.

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胃穿透性潰瘍侵蝕胰腺及脾臟血管： 1例報道及文獻復習

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