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1 病历简介患者男性,21岁,4次手术经历如下:患者因上腹部疼痛、黑便,行胃肠钡餐检查,发现十二指肠球部溃疡,行胃大部切除,胃空肠吻合。术后2个月反复出现上腹部疼痛、黑便、贫血,再次手术,术中发现吻合口溃疡,切除吻合口及部分胃体后行胃空肠Roux-Y吻合。术后10天出现上腹部疼痛、黑便、严重贫血而转入我院。查体:面色苍白,极度衰竭,血压13/5kPa,脉搏120次/分,血红蛋白20g/L。术中见吻合口后壁胃侧有一个直径1cm的溃疡,已穿透胃壁与胰腺粘连。切除吻合口和部分残胃,行胃空肠Roux-Y吻合。术后从胃管中每天抽出胃液约2000ml,于术后第7天出现腹痛、黑便。术后20天胃镜检查发现吻合口后壁
1 medical history of patients Men, 21 years old, 4 surgical experience as follows: patients with upper abdominal pain, melena, gastrointestinal barium meal examination, found duodenal ulcer, gastrectomy, gastrojejunostomy. After 2 months of operation, epigastric pain, melena, and anemia were repeated. The operation was performed again. Anastomotic ulcer was found during the operation. Roux-Y anastomosis was performed after the anastomosis and part of the corpus was removed. Ten days after surgery, upper abdominal pain, melena, and severe anemia developed and were transferred to our hospital. Physical examination: pale, extremely depleted, blood pressure 13/5 kPa, pulse 120 beats/minute, hemoglobin 20 g/L. During the operation, an anastomotic ulcer with a diameter of 1 cm was found on the posterior wall of the anastomotic stoma, which penetrated the stomach wall and adhered to the pancreas. The anastomosis and part of the stomach were resected and Roux-Y anastomosis was performed. After the operation, about 2000 ml of gastric juice was withdrawn from the stomach tube every day. Abdominal pain and black stool occurred on the 7th day after operation. Gastroscopy on the posterior wall of the anastomosis after 20 days after operation