胃十二指肠穿孔非手术治疗后早期病因根除手术的适应证与时机探讨

目的探讨胃十二指肠穿孔（perforated gastro-duodenum，PGD）非手术治疗后，早期选择性病因根除手术治疗的时机和适应证。方法2001年10月至2007年3月间116例PGD非手术治疗后的患者中，对经确诊并需尽早行病因根除手术的7例实施早期手术治疗，包括十二指肠溃疡（duodenal ulcer，DU）合并疤痕性梗阻、十二指肠瘘、十二指肠憩室各1例、胃癌2例及强烈要求手术治疗的DU 2例。结果7例患者实施手术的时间为穿孔闭合后4-23 d，即急诊入院后7-28 d，手术均顺利完成并痊愈出院，无相关手术并发症。结论PGD非手术治疗后使穿孔闭合后，对于有手术适应证并需要尽早手术者，早期行病因根除手术治疗是可行的，但应严格掌握适应证。

Investigation of the Indications and Opportunity of Early Primary Lesion Resection Following conservative Treatment in Perforated Gastro-duodenum Patients

Objective To discuss the indications and opportunity of early primary lesion resection after conservative therapy in perforated gastro-duodenum（PGD） patients.Methods From October 2001 to March 2007,116 cases of PGD received conservative therapy,in which 7 underwent early operations because of 3 of duodenal ulcers（DU） combined with cicatricial obstruction,duodenal fistula,or duodenal diverticulum,2 of gastric cancer,and 2 of DU with intense operation request.Results In all the 7 cases,the operations were done when 4 to 23 days after the perforation closed up,that was 7 to 28 days after admission.All patients healed smoothly without complication.Conclusions It is safe and feasible for early operation in PGD patients after non-operative surgery,but indications should be strictly controlled.