经验性临床诊断胃十二指肠溃疡穿孔合理性的评价

Evaluation in rationality of clinical experiential diagnosis for perforated gastroduodenal ulcer

目的探讨临床诊断(急诊时尚无影像学确诊依据者)PGDU的合理性及其对非手术治疗方式的影响。方法对本院急诊入院时临床诊断PGDU,并采用行非手术治疗的117例患者,在根据临床指标认定穿孔闭合后经住院期间胃镜检查,以及中转手术探查,明确其穿孔病因诊断及其病理改变。结果入选者经非手术治愈114例,其中,确诊穿孔病因为胃十二指肠溃疡(GDU)111例,占受检者97.3%;胃癌2例,占1.8%;十二指肠憩室1例,占0.9%。中转急诊手术3例,均为十二指肠溃疡(DU)。结论在急诊的特定情况下,临床诊断PGDU有其合理性,但其中非溃疡因素应引起重视,PGD非手术治疗后早期胃镜检查对确定病因诊断及后续治疗的选择具有重要意义。

Objective To investigate the rationality of clinical diagnosis of PGDU （without imaging cnfirmed diagnosis during emergency） and it＇s effect on selection of therapeutic manner following conservative treatment. Methods From October 1997 to January 2007, 117 cases with emergency diagnosis as PGDU underwent conservative treatment. According to clinical index believed closure of perforation, through gastroscopy and partial patients transferred to operative exploratin, the causal diagnosis of perforation and pathological changes were confirmed. Results 114 of 117 cases were cured by conservative treatment. Among them, perforated cause was confirmed as gastroduodenal ulcer in 111 cases（111/114,97.3%）,gastric carcinoma in 2 cases（1.8%）,duodenal diverticulam in 1 case （0,9%）. In the transferred to emergency operation patients, 3 cases were duodenal ulcer. Conclusion In the emergent special conditon, clinical diagnosis of PGDU has definite rationality. But, it＇s non-ulcerative factors should be induce attention. Early gastroscopy has an important value to confirm causal diagnosis and selection of consecutive treatment after conservative treatment of PGDU.