急性胃十二指肠穿孔手术治疗临床分析

目的分析总结急性胃十二指肠穿孔手术治疗体会。方法随机选取2006年9月—2011年9月在该院就诊的60例胃十二指穿孔患者,对其临床资料进行回顾性分析。结果在60例患者中,胃溃疡穿孔患者14例(23.3%),十二指肠溃疡穿孔患者46例(76.7%)。其中青年患者居多,但呈下降趋势,然而老年患者则呈上升趋势。服用非甾体类抗炎药物(NSAIDS)与老年患者的发病具有密切关系(P<0.05)。60例患者中10例实行保守治疗,1例因中毒性休克死亡,并发症3例;30例采用单纯穿孔缝合术,无一例死亡,并发症1例;10例采用穿孔缝合术+高选择性迷走神经切除,无一例死亡,并发症1例;10例采用胃大部切除术,1例死亡,并发症2例。单纯穿孔缝合术产生的并发症少于保守治疗和胃大部切除术的并发症(P<0.05),并且其术后的复发率与穿孔缝合术+高选择性迷走神经切除差异无统计学意义(P>0.05)。结论单纯穿孔缝合术手术操作简单、便捷,麻醉时间较短,创伤较轻并且术后恢复快,值得临床手术治疗借鉴使用。

Clinical analysis of the treatment of operation of acute perforation of gastroduodenal ulcer

Objective To summarize and analyze the experience of operation treatment of acute gastroduodenal perforation. Methods Randomly selected from 2006 September to 2011 September in our hospital 60 cases of gastric perforation in patients with twelve fingers, retrospective analysis of the clinical data. Results In 60 patients, 14 patients with perforation of gastric ulcer （23.3%）, 46 patients with perforation of duodenal ulcer （76.7%）. The young patients are in the majority, but the downward trend, but the elderly patients were increased. Non-steroidal anti-inflammatory drugs （NSAIDS）has a close relationship with the disease in the elderly patients （P 〈 0.05）. In 60 patients, 10 cases of conservative treatment, 1 cases died of toxic shock, complications in 3 cases; 30 cases underwent simple suture of perforation, and no case of death, complications in 1 cases; 10 cases with perforation suture ＋ high selective vagotomy, no cases of death, complications in 1 cases; 10 cases with gastric gastrectomy, 1 cases died, 2 cases with complications. Simple suture of perforation resulting complications than resection complications of conservative treatment and subtotal gastrectomy （P 〈 0.05）, and the postoperative recurrence rate and suture of perforation ＋ high selective vagotomy without significant difference （P 〉 0.05）. Conclusion Simple suture of perforation operation simple and convenient operation, anesthesia time is short, trauma lighter and faster postoperative recovery, is worthy of clinical operation for reference use.