消化性潰瘍病人手術須知
PEPTIC ULCER SURGERY
Why is Peptic Ulcer Surgery Performed?
If you have a peptic ulcer, it is likely to respond well to treatment with drugs. However, some ulcers may be resistant to treatment, and others will recur when medication is stopped. There are two types of peptic ulcer, gastric (stomach) and duodenal. Operations are performed to treat gastric ulcers that do not respond to other types of treatment because there is a small risk that the ulcer may be malignant. Gastric or duodenal ulcers which return when the medical treatment is stopped also sometimes warrant surgery. When chronic duodenal ulcers produce scarring of the outlet of the stomach, preventing it from emptying (pyloric stenosis), an operation becomes necessary. Emergency surgery will be required if an ulcer bleeds, or if it causes a perforation in the stomach wall.
Preparations for Peptic Ulcer Surgery
You will probably be admitted to hospital the day before surgery. Normally seven to ten days have to be spent in hospital following surgery and a further one month off work is required following discharge.
What Happens during Peptic Ulcer Surgery
The aim of the operation is to remove the ulcer-bearing part of the stomach. Duodenal ulcers occur as the result of too much acid being produced by the stomach. The operations for duodenal ulcer are therefore directed at reducing the amount of acid produced. This may be achieved just by cutting the nerves to the stomach that stimulate acid to be produced (vagotomy). Alternatively, one can remove the part of the stomach which produces the acid (partial gastrectomy). All operations for ulcers are performed under general anaesthesia. When the patient is asleep, the following tubes may be inserted for use during and after the operation. An intravenous drip into one arm will allow the administration of fluids, drugs, antibiotics or blood as required during and following surgery. The drips are maintained until the intake of fluids and food can be commenced. A tube will be passed through the nose into the stomach to prevent the accumulation of gastric juices within the stomach. This is left in place until there is clear evidence that normal emptying of the stomach has resumed. A tube drain is placed through the wall of the abdomen to prevent accumulation of blood or fluid. These tubes are removed between 2 and 7 days after surgery. A urinary catheter may be introduced into the bladder to remove urine. This eliminates the need to pass urine in the immediate post-operative period. It will be removed when the patient’s condition stabilizes and the patient is able to pass urine unaided. Small amounts of fluid may be taken orally immediately after the operation. Larger quantities are withheld until the surgeons are sure that bowel activity has returned to normal. This usually takes between 5 and 7 days.
Possible Complications during Peptic Ulcer Surgery
The possible complications are the same as those for any major abdominal operation: infections of the chest, wound or urine and thrombosis (blood clots) in the veins of the leg. In a few cases, the ulcer may recur despite cutting the nerves to the stomach (vagotomy). In a few patients, severe diarrhoea may occur, but this usually responds to treatment with codeine. Occasionally, vomiting of bile may occur due to the way the stomach has been reconstructed. This may respond to tablets, but occasionally requires further surgery. Sweating attacks (dumping) may occur due to the rapid emptying of the stomach. These may be ameliorated by taking sugar in the form of a sweet drink or chocolate. Anaemia is a long-term risk, since the stomach is involved in the absorption of iron and vitamin B12. This can be simply remedied by vitamin injections and iron and folic acid tablets as required.
After Peptic Ulcer Surgery
Discharge from hospital will take place approximately 7 to 10 days after operation. The skin stitches will usually have been removed by this time. At the time of discharge, you will be told whether iron or vitamin supplements are necessary and if vitamin injections are required, the necessary arrangements will be made with your GP. On returning home, be prepared to rest as much as possible by going to bed early and getting up late. Gradually try to increase the amount of exercise you take each day to restore the strength of your muscles. It will take at least a month before 70 80% of your energy returns and it may be 2 3 months before pre-operative energy levels are achieved. At least one month's convalescence at home is required before contemplating a return to work. Usually, an outpatient appointment will be given for the end of this time to review your progress. If part of the stomach has been removed, a sensation of fullness after eating will be present. This can be reduced by eating small meals frequently and drinking liquids 1 to 2 hours after your meal. This sensation will gradually improve with time, as the remaining stomach adjusts to the new situation. If satisfactory progress has been made by the time of the follow-up outpatient appointment, you may be discharged back to the care of your GP. An annual blood count is usually performed, either by the hospital, or by your GP, to ensure that you do not become anaemic.
If Peptic Ulcer Surgery is not performed
Gastric ulcers which fail to heal on adequate medication may be malignant. If these are not operated on, the outcome could be serious. Duodenal ulcers that have been present for some time produce scarring of the exit of the stomach. This scarring may prevent the stomach from emptying.
Effects on Family of Peptic Ulcer Surgery
It is sensible to warn your family that you will be attached to various tubes in the first days after the operation so that they do not become alarmed. Ask your family and friends who wish to bring you food and drink to check with the Ward Sister to see if it is appropriate. You should also explain to your immediate family that on your return home your eating patterns may be altered to allow your operated stomach to adjust to its new situation.