326例上消化道溃疡穿孔诊治体会

目的探讨胃十二指肠溃疡穿孔的特征和治疗方法。方法回顾本院1995-2009年收治的胃十二指肠溃疡穿孔患者病例资料,对年龄、发病至就诊时间、治疗等进行分析。结果共收治胃十二指肠溃疡穿孔患者共326人。有240例可见不同程度的隔下游离气体,其中25例经胃管注气后再行腹部立卧位X线检查发现隔下游离气体,阳性率为81.29%。消化性溃疡患者中,35岁以下所占比重逐渐下降,而55岁以上患者的比率逐渐增加,老年性患者使用非甾体类消炎药的比率随时间的推移逐渐增加。269例行单纯穿孔缝合术,18例行胃大部分切除术,穿孔缝合＋高选迷走神经切断6例,保守治疗33例。结论根据病史、体征和积极的腹部X线一般可诊断。消化性溃疡的患者中,老年人的比率呈现逐渐增高的趋势,可能与老年性患者非甾体类消炎药使用机率的增加有关。上消化道溃疡穿孔行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。

Clinical analysis of 326 cases with acute perforation of upper digestive tract

Objective To study the clinical characteristics and the methods of diagnosis and treatment for peptic ulcer perforation.Method The clinical data of patients with peptic ulcer perforation treated from January 1995 to December 2009 were analyzed.Results There were 326 cases.Subdiaphragmatic free-air was shown in 240 cases.After injected air through gastric tube,positive rate was increased to 81.29%.Simple suture closure of the perforation were performed in 269 cases,subtotal gastrectomy in 18 cases,6 patients with selective vagotomy plus suture closure,while 33 cases were treated by conservative therapy.Conclusions Diagnosis could be achieved according to history physical sign and abdominal X-rays.Due to the increased prescriptions for NSAIDs,percentages of old patients increased in the same period.Simple suture closure of the perforation is simple,safe with less complication,and remain to be a modus operation of peptic ulcer perforation.