重新评估非手术治疗十二指肠溃疡穿孔的地位

目的 重新评估幽门螺杆菌时代非手术治疗十二指肠溃疡穿孔的地位。方法 回顾性分析过去8年间54例十二指肠溃疡穿孔患者非手术治疗的临床资料。结果 43例(79.6％)经过非手术治疗成功(含1例并发肠袢间脓肿);11例中转开腹手术,其中死亡1例,并发胃瘫1例;全组病死率1.9％,并发症发生率3.7％。非手术治疗组与中转开腹手术组间年龄、溃疡病史、穿孔时间和有无膈下游离气体等方面差异无显著性意义(均P>0.05);而是否空腹穿孔、腹膜炎的范围、腹穿结果和泛影葡胺造影结果组间差异有显著性意义(均P<0.05)。31例非手术治疗成功者获得1～8年的随访,有28例治愈,1例死于溃疡无关的内科疾病,2例因内科治疗效果不佳而进行了外科治疗。结论 合理掌握适应证,非手术治疗是处理十二指肠溃疡穿孔安全有效的重要治疗方法之一。

Reappraisal of non-operative treatment for perforated duodenal ulcer

Objective To reappraise the role of non-operative treatment for perforated duodenal ulcer. Methods During the last 8 years, a total of 54 patients with perforated duodenal ulcer were treated non-operatively and the results were analyzed retrospectively. Results Forty three patients(79.6%) were successfully treated with non-operative methods, and one patient was complicated with inter-intestinal abscess. Eleven patients were switched to surgical intervention. One patient died and one had gastroparesis. The overall mortality and morbidity rate were 1.9% and 3.7% respectively. There were no significant differences between successful and failing non-operative treatment groups in age, duration of perforation, ulcer history, free gas under diaphragm(P>0.05), but the differences were statistically significant in fasting perforation, extension of peritonitis, results of abdomen puncture, findings of gastroduodenogram with water-soluble contrast medium (P<0.05). Thirty one patients were followed up and the duration of follow-up was 1 to 8 years. Twenty-eight patients were cured, one patient died of other disease, 2 patients underwent gastrectomy because of inefficacious medical treatment. Conclusions Non-operative treatment is one of safe, effective and reasonable options to treat perforated duodenal ulcer provided strict criteria and guidelines are followed. Close attention should be paid to the benefit of non-operative treatment for perforated duodenal ulcer in the Helicobacter pylori era.