胃十二指肠溃疡穿孔手术治疗的术式选择

Selection of operative treatment for acute perforation of gastroduodenal ulcer

目的:观察穿孔修补,术后抗菌、抑酸和保护胃肠黏膜等综合治疗胃十二指肠溃疡穿孔的临床疗效,重新评价胃大部切除术在胃十二指肠溃疡穿孔中的临床应用.方法:选择61例胃十二指肠溃疡穿孔且溃疡直径＜2 cm的患者行单纯修补术,术后胃肠减压、输液,并应用抗生素和抑酸剂.出院后给予抑酸剂、抗幽门螺杆菌药物和黏膜保护药物治疗,并随访其康复情况.结果:本组61例患者均顺利出院,服药痊愈后随访2～5年,胃十二指肠黏膜幽门螺杆菌检测均为阴性,无复发病例.结论:胃大部切除术在胃十二指肠溃疡穿孔中的临床应用应重新评价.术中穿孔修补,术后抗菌、抑酸和保护胃肠黏膜等应成为首选的治疗方案.

Objective To reevaluate the application of partial gastrectomy for acute perforation of gastroduodenal ulcer by observing the clinical effect of simple oversewing of the ulcer, antibiotics, suppression of acid secretion and mucosal protectants.Methods Sixty-one cases of acute perforation of gastroduodenal ulcer with the dimension of ulcer less than 2 cm received simple oversewing, gastroin- testinal drainage, infusion, antibiotics post-operatively and drugs such as antiacids, eradicating heli- cobacter pylori and mucosal protectants after leaving hospital. Results All the 61 cases recovered, af- ter 2~5-year follow-up. Helicobacter pylori showed negative in the mucous of gastroduodenal. There was no recurrence of ulcer.Conclusion The application of partial gastrectomy for acute perforation of gastroduodenal ulcer should be reevaluated.Simple oversewing of the ulcer, antibiotics, suppression of acid secretion and mucosal protectants should be the first procedure.