胃十二指肠溃疡穿孔合并幽门狭窄临床治疗研究

目的探讨治疗胃十二指肠溃疡穿孔合并幽门狭窄的简单有效、创伤小的手术治疗方案及合理的联合术后正规溃疡维持治疗方案。方法治疗组对36例术中确诊为胃十二指肠溃疡穿孔合并幽门狭窄的患者行溃疡穿孔灶菱形切除联合幽门成形术,术后给予奥美拉唑,常用剂量为(20～40)mg/d,睡前一次服用,维持6个月;合并Hp感染者,同时给予德诺(枸橼酸铋钾)240mg,每日2次,灭滴灵400mg,每日2次,阿莫西林500mg,每日2次,口服4周。对照组术后未给予相关药物治疗。结果 36例患者无嗳气、反酸、腹胀、呕吐现象,均痊愈出院,3个月～半年常规复查胃镜,显示溃疡无复发,幽门通畅,且随访期间无溃疡症状复发者。治疗组的手术时间、术中出血量、术后肠蠕动恢复时间和住院时间明显少于对照组,差异均有统计学意义(P0.01)。结论溃疡穿孔灶菱形切除联合幽门成形术加术后正规溃疡维持治疗胃十二指肠溃疡穿孔合并幽门狭窄疗效显著,优于单纯手术治疗。

Clinical Study of Gastric Ulcer Perforation and Clinical Treatment of Pyloric Stenosis

Objective To investigate the gastroduodenal ulcer perforation and pyloric stenosis is simple and effective treatment in combination with minor surgery and trauma patients to maintain regular ulcer treatment. Methods The treatment group：36 cases of patients diagnosed with gastric ulcer perforation in the pyloric stenosis combined perforated ulcer patients with focal resection and pyloroplasty diamond,after giving omeprazole,used a dose of （20 -40）mg/d,sleep the previous taking it for 6 months;combined I-Ip infection,while giving dno （bismuth potassium citrate）240mg,2 times a day,metronidazole 400mg,2 times a day and amoxicillin 500mg,2 times a day,orally for 4 weeks. Related to the control group were not given medication. Results 36 patients had no belching,acid regurgitation,abdominal distension,vomiting were cured, 3 months to six months of conventional endoscopy, showed no recurrence of ulcer,pyloric smooth,and no ulcer symptoms during the follow-up recurrence. Treatment group the operation time,blood loss, postoperative bowel recovery time and hospitalization time was significantly less than the control group,the differences were statistically significant,all P〈0.01. Conclusion The diamond-shaped ulcer lesions removed after combined pyloroplasty plus regular maintenance treatment of gastric ulcer duodenal ulcer perforation and pyloric stenosis a significant effect,better than surgery alone.