15年胃十二指肠溃疡急性穿孔发病情况及变化趋势

目的研究近15年来胃十二指肠溃疡急性穿孔的发病情况及变化趋势,探讨其可能机制。方法对1991～2005年收治的胃十二指肠溃疡急性穿孔患者的病例资料进行分析。结果男性患者平均年龄为（39±2）岁;女性患者平均年龄为（58±7）岁,老年患者比重有逐年增加趋势。服用非甾体消炎药者41例,其中老年患者37例。好发于气温骤变以及寒冷季节。吸烟患者279例,占85.58%。吸烟人群发病危险性为不吸烟人群的4倍。确定性手术方式如胃大部分切除术、高选择性迷走神经切除加穿孔修补术逐渐减少,而单纯穿孔修补术逐渐增加。结论胃十二指肠溃疡急性穿孔是多因素作用的结果 ：非甾体消炎药的使用,吸烟、天气变化等均与其发病有关。发病年龄趋于高龄化,非甾体类消炎药可能是老年患者的主要因素。单纯穿孔修补术是大多数病例的首选治疗方式。

Prevalence Situation and Trends of Acute Perforation of Gastroduodenal Ulcer in Recent 15 Years

Objective To research the prevalence situation and trends of acute perforation of gastroduodenal ulcer in recent 15 years,and explore its possible pathogenesy.Methods The records of 326 cases with acute perforation of gastroduodenal ulcer from 1991 to 2005 were analyzed retrospectively.Results The average age of onset for male was（39±2）years,and for female was（58±7）years.Emergency operabilities for gastric and duodenal ulcer perforation increased among older patients.Forty one cases（37 senile patients）were taking non-steroid anti-inflammatory drugs（NSAID）.Episodic attacks occurred mostly in winter and in days that season changed.Ulcer perforation was estimated to be 4 times more common in cigarette smokers than that in non-smokers.Immediate definitive ulcer surgery including partial gastrectomy and highly selective vagotomy decreased,but simple closure increased in the treatment of peptic ulcer perforation.Conclusion Several factors,such as the use of NSAID,smoking and seasonal variation,are responsible for the acute perforation of gastroduodenal ulcer.The age related tends may be caused by the taking of NSAIDs.The simple closure of peptic ulcer perforation is an adequate surgical treatment.