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1991～2002年间收冶的166例消化性溃疡穿孔患者的临床资料进行回顾性分析。结果166例中，术前确诊152例(91．6％)，误诊14例(8．4％)。行保守治疗20例(12．0％)，无中转手术病例。穿孔修补术28例(16．9％)，胃大部分切除术118例(71.1％)，术后无再穿孔、幽门梗阻、吻合口漏和残端破裂等近期严重并发症及死亡病例。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。胃大部分切除术的近期并发症与单纯穿孔修补术或非手术疗法并发症的发生无显著性差异，但远期疗效优于后两者。

Diagnosis and treatmeat of acute perforation of peptic ulcer

Objective To summarize the experience of diagnosis and surgical treatment of perforation of peptic ulcer, to improe the diagnosis and treatment. Methods Retrospective analysis on the clinical data of 166 patients with perforation of peptic ulcer admitted to our hospital from 1991 to 2002. Results Out of the 166 cases, the diagnosis was made preopratively in 152 cases (91.6%), and misdiagnosed in the other 14 cases (8.4%). 20 cases (12.0%) underwent non-operative treatment, 28 cases (16.9%) underwent simple closure operation, and 118 cases (71.1%) underwent subtotal gastrectomy. There was no operative mortality or reperforation; no pylorochesis, anastomotic leakage or duodenal stump fistula in this series. Conclusions Combining use of X-ray with B-ultrasoned examination can apparently improve the diagnosis rate. The early postoperative complications in subtotal gastrectomy group comparing with simple closure operation group and non-operative treatment group were no significant diffrent,but the long-term effect of subtotal gastrectomy was much better than that of other two groups.