胃大部切除术与单纯修补术在治疗胃十二指肠溃疡急性穿孔中的效果分析

目的 探讨胃大部切除术与单纯修补术在治疗胃十二指肠溃疡急性穿孔中的效果.方法 选取368例胃十二指肠溃疡急性穿孔患者,根据手术方法不同随机分为单纯修补术组（A组）174例、胃大部切除术组（B组）194例,比较两组的临床疗效.结果 胃大部切除术组患者的手术时间、术后住院时间和术中出血量明显高于行单纯修补术组患者（P＜0.05）.胃大部切除术组患者术后患粘连性梗阻的风险是单纯修补术组的1.45倍（95% CI：1.32~1.58）,腹腔脓肿的风险是单纯修补术组的1.34倍（95% CI：1.26~1.41）,患伤口感染的风险是单纯修补术组的1.52倍（95% CI：1.38~1.67）.两组患者术后溃疡复发率没有明显差别（P＞0.05）.结论在病情允许的情况下,单纯修补术是治疗胃十二指肠溃疡急性穿孔的首选手术方式.

Analysis of the Effectiveness of Treatment for Acute Perforation of Gastroduodenal Ulcer with Simple Repair and Subtotal Gastreetomy

Objective To analyze and compare the effectiveness of treatment for acute perforation of gastroduodenal ulcer with simple repair and subtotal gastreetomy. Methods 368 patients with acute perforation of gastroduodenal ulcer were randomly divided into two groups： group A （simple repair） and group B （subtotal gastreetomy）, and then whether there were in significant differences between two groups were analyzed. Results Multiple linear analysis showed that operation time, hospitalization and bleeding of patients with subtotal gastreetomy were higher than the patients with simple repair （P 〈 0.05 ）. Patients with subtotal gastreetomy had a higher risk of adhesive obstruction than patients with simple repair （95% CI： 1.32 -1.58 ）. Patients with subtotal gastreetomy had a higher risk of abdominal ab- scess than patients with simple repair （95 % CI： 1.26 - 1.41 ）. And patients with subtotal gastreetomy had a higher risk of wound infection than patients with simple repair （95% CI： 1.38 - 1.67）. Conclusion Simple repair was the best choice for treating acute perforation of gastroduodenal ulcer under appropriate circumstances.