胃穿透性溃疡侵蚀胰腺及脾脏血管： 1例报道及文献复习_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

李依宸 ¹ , 谭春路 ¹ , 陈拥华 ¹ , 刘续宝 ¹ ,  易智慧 ²

1. ;
2. ;

Corresponding author：

易智慧, Email: yzh616@163.com

Keywords：

消化性溃疡; 穿透性溃疡; 手术治疗

DOI：

10.7507/1007-9424.202308018

Video：

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目的总结胃穿透性溃疡侵蚀胰腺及脾脏血管患者的诊治经验，为临床诊治提供一定的参考。方法回顾四川大学华西医院收治的1例胃穿透性溃疡侵蚀胰腺及脾脏血管患者的病程发展、诊治过程及临床结局，并结合在中英文数据库中检索到的相关病例进行讨论，对本病临床特征、治疗措施、临床结局等进行总结。结果本例患者行近端胃切除术、脾切除术及胰腺修补术，术后检查及随访结果提示患者痊愈。共检索到27篇相关病例的文献报道，包括本例患者在内共30例患者，其中男21例、女9例，发病年龄为（56.7±13.2）岁，临床症状以上腹部疼痛为主（66.7%），溃疡好发于胃小弯（26.7%）及胃后壁（23.3%），穿透性溃疡最大直径为（4.2±2.4）cm，易受侵犯部位包括胰腺（40.0%）、脾脏血管（33.3%）、肝脏（33.3%），治疗方案以胃部分切除术为主（27.2%），受溃疡侵蚀组织器官多采取局部修补手术治疗（68.2%）。结论胃穿透性溃疡为消化性溃疡少见并发症，患者应行消化内镜及腹部CT评估溃疡进展情况。若已经发生溃疡穿透，则应积极开展手术治疗并及时处理病灶，避免穿透进一步侵蚀周围器官及重要血管。

Citation： 李依宸, 谭春路, 陈拥华, 刘续宝, 易智慧. 胃穿透性溃疡侵蚀胰腺及脾脏血管： 1例报道及文献复习. 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. 以胸痛为主诉的胃穿透性溃疡并腹腔脓肿1例报道. 胃肠病学和肝病学杂志, 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.	唐子东, 王芳. 胃底部穿透性溃疡并巨大假憩室误诊1例. 罕少疾病杂志, 2002, 9(5): 41-41.
11.	刘鸿章, 薛琪彪. 胃窦部后壁穿透性溃疡并胃十二指肠瘘1例. 实用医学杂志, 2001, 17(5): 444.
12.	陈志新, 胡建昆, 何生, 等. 胃穿透性溃疡侵蚀脾静脉致失血性休克1例报告. 中国普外基础与临床杂志, 2001, 8(4): 214.
13.	孙赣清, 陈雪峰, 张文军, 等. 胃体后壁大弯侧巨大穿透性溃疡1例报告. 现代医用影像学, 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.	杨贵龙, 马宏波, 邹德龄. 胃角部溃疡穿孔并窦部后壁穿透性巨大溃疡1例. 黑龙江医学, 1999, 176(2): 84.
17.	来永德, 祁静, 陆惠良. 胃角慢性巨大穿透性溃疡一例. 上海医学, 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, Muñoz-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.	韦士康. 胃后壁巨大穿透性溃疡1例报告. 临床外科杂志, 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. 以胸痛为主诉的胃穿透性溃疡并腹腔脓肿1例报道. 胃肠病学和肝病学杂志, 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. 唐子东, 王芳. 胃底部穿透性溃疡并巨大假憩室误诊1例. 罕少疾病杂志, 2002, 9(5): 41-41.
11. 刘鸿章, 薛琪彪. 胃窦部后壁穿透性溃疡并胃十二指肠瘘1例. 实用医学杂志, 2001, 17(5): 444.
12. 陈志新, 胡建昆, 何生, 等. 胃穿透性溃疡侵蚀脾静脉致失血性休克1例报告. 中国普外基础与临床杂志, 2001, 8(4): 214.
13. 孙赣清, 陈雪峰, 张文军, 等. 胃体后壁大弯侧巨大穿透性溃疡1例报告. 现代医用影像学, 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. 杨贵龙, 马宏波, 邹德龄. 胃角部溃疡穿孔并窦部后壁穿透性巨大溃疡1例. 黑龙江医学, 1999, 176(2): 84.
17. 来永德, 祁静, 陆惠良. 胃角慢性巨大穿透性溃疡一例. 上海医学, 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, Muñoz-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. 韦士康. 胃后壁巨大穿透性溃疡1例报告. 临床外科杂志, 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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

胃穿透性溃疡侵蚀胰腺及脾脏血管： 1例报道及文献复习

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