385例胃十二指肠溃疡穿孔临床分析

Clinical analyse on 385 cases of perforated gastroduodenal ulcer

目的 分析胃十二指肠溃疡穿孔临床特点及治疗的疗效。方法 对我院1988年至2002年收治的385例溃疡穿孔病人临床特点。治疗疗效总结分析。结果溃疡穿孔发病年龄有上升趋势,溃疡穿孔发病率无明显降低。非手术疗法和单纯缝合后溃疡复发率相似(7/54,16/146),单纯缝合修补无手术死亡,平均手术时间42min,平均住院时间9d,均 显著短于胃大部分切除和高选迷切加修补术(P<0.01),且单纯缝合术后1、3、5年溃疡复发率分别为11％(16/146),22％(27/121)和25％(24/96)与高选迷切加修补相比,无显著差异(P>0.05),远期并发症发生率为8％(12/146),亦低于后二者(P<0.05)。结论溃疡穿孔单纯缝合修补,操作简单、安全、并发症少,术后结合正规内科治疗,效果满意。

Objective To analyse the clinical characteristic and the therapeutic effect of the perforated gastroduodenal ulcer(PGU). Methods The clinical characteristic and the therapeutic effect of 385 cases with PGU were summarized. All patients were treated in our hospital from 1988 to 2002. Results The age of the patients with PGU was showing a tendency of older. The incidence rate of PGU was not reduced remarkably. The recurrent rate of nonoperative therapy and simple suture closure were similar(7/54,16/14 6).The operative and hospitalization time of suture closure were 42 minutes and 9 days, respectively,much shorter than that of subtotal gastroctomy and uhraselective vagotomy plus suture closure(P>0.01).The 1-, 3- and 5- year recurrent rate of ucler were 11%(16/146),22%(27/121) and 25%(24/96) respectively,which were no different from that of ultraseleetive vagotomy plus suture closure (P>0.05), The long-term postoperative complication rate was 8%,much lower than that of the other two operations. Conclusion The result of this study demonstrates that suture closure for PGU is simple, safe and with less complications, most patients do well with postoperative standard medical treatment.