基层医院胃十二指肠溃疡急性穿孔64例诊治体会

目的探讨基层医院胃十二指肠溃疡急性穿孔的诊断和治疗方法。方法对我院外科1996年1月到2006年12月收治的64例胃十二指肠溃疡急性穿孔患者的临床资料进行回顾性分析。结果6例保守治疗（其中的2例因治疗无效中转手术治疗）,60例行手术治疗。其中28例行单纯穿孔修补术,32例行胃大部分切除术。死亡1例。治愈率98.4%。结论胃大部切除术是基层医院常用治疗胃十二指肠溃疡穿孔的手术。然而,溃疡穿孔修补＋扩大壁细胞的迷走神经切除术术后疗效好,并发症少,手术操作易于掌握,值得在基层医院开展使用。

Experience of diagnosis and treatment for 64 cases with perforated gastroduodenal ulcer in basic hospital

Objective To investigate the diagosis and therapeutic methods for acute perforated gastroduodenal ulcer in basic hospital. Methods From January 1996 to December 2006,the clinical data of 64 cases with aute perforated gastroduodenal ulcer were analyzed retrospectively. Results 6 cases underwent conservative treatment (Among them,2 cases were converted to open abdominal operation because of patient's deteriorated condition), 60 cases underwent operative treatment and among them,28 cases underwent simple repair of ulcerative perforation, 32 cases underwent subtotal gastrectomy. 1 case died from postoperative severe pulmonary infection. The cure rate was 98.4%. Conclusion The subtotal gastrectomy is a common surgical procedure for the treatment of perforated gastroduodenal ulcer in basic hospital. However,the repair of perforated ulcer plus extended parietal cell vagectomy(EPCV)has many advantages such as good efficacy, less postoperative complications and easy to control operative manipulation. So it can use worthily in basic hospital.