消化性溃疡穿孔的诊断和治疗

目的　总结消化性溃疡穿孔的外科诊治经验 ,以提高对溃疡病穿孔的诊治水平。方法　对 12 4例消化性溃疡穿孔患者的临床资料进行回顾性分析。结果　 12 4例患者 ,术前确诊 116例 (93.5 % ) ,误诊 8例 (6 .5 % )。保守治疗 13例 (10 .5 % ) ,无中转手术病例。穿孔修补术 76例 (6 1.3% ) ,胃大部切除术 35例 (2 8.2 % ) ,除 1例死于多器官功能衰竭外 ,余均痊愈出院。结论　术前X线和B超联合应用可提高溃疡病穿孔的确诊率。溃疡穿孔单纯缝合修补操作简单、安全、并发症少 ,术后结合正规内科治疗 ,效果满意。胃大部切除术去除了溃疡病灶和泌酸环境 ,达到了根治的目的。

Diagnosis and treatment of acute peptic ulcer perforation

Objective To summarize the experience of diagnosis and surgical treatment of perforation of peptic ulcer for improving the diagnosis and treatment. Methods Clinical data of 124 patients with perforation of peptic ulcer were analyzed retrospectively. Results Of the 124 patients, the diagnosis was made preopratively in 116(93.5%), and misdiagnosed in the other 8 (6.5%).Thirteen patients (10.5%)received non-operative treatment, 76 (61.3%) simple closure operation, and 35 (28.2%) subtotal gastrectomy. Except one patient died of MSOF, the others were cured. Conclusion Combining use of X-ray with B-ultrasouned examination can apparently improve the diagnosis rate. Simple suture for the perforated peptic ulcer is a simple and safe method with less complications. It promises a good prognosis to the patients who accept postoperative standard anti-Hp therapy. Subtotal gastrectomy can remore of the ulcer and the acid secretion.