胃十二指肠穿孔的治疗

Treatment for gastric and duodenal perforation

目的:回顾性分析胃十二指肠穿孔患者的临床表现、诊断及治疗方法。方法:67例患者中,12例保守治疗成功,55例手术治疗,其中,穿孔修补术18例,大部切除术37例(毕Ⅰ式13例,毕Ⅱ式24例)。结果:所有患者均治愈,无死亡发生;切口感染3例,肺部感染、倾倒综合征、碱性反流性胃炎及肠梗阻各1例,均经积极治疗后痊愈。术后随访6个月～3年,3例复发,2例胃癌患者分别亡于术后第6个月及13个月。结论:准确采取病史并综合利用各种辅助检查有助于提高诊断准确率,外科干预在胃十二指肠穿孔的治疗中占有重要地位,术中应该根据患者的具体情况制定个体化的手术方式。

Objective：To retrospectively analysis the clinical manifestation,diagnosis and treatment of patients with perforation history of stomach or duodenum. Methods： 67 patients with gastric and duodenal perforation were enrolled our study. 12 of them were successfully treated by conservative treatment, while the other 55 receive operation. Of which, 18 cases underwent simple closure for the perforation and 37 underwent subtotal gastrectomy（ Billroth I anamosis 13,Billroth 11 anamosis 24）.Results：All the patients fully recovered from their illness, with no death happened.3 wound infection, 1 pulmonary infection, 1 dumping syndrom,1 alkaline 1 reflux gastritis and 1 ileus occurred respectively after operation, but they were cured by active treatment. All the patients were followed up 6 months to 3 years. 3 relapsed and 2 stomach cancer patients died 6 months and 13 months postoperatively. Conclusion：Detailed History-taking and multiple utilization of various auxiliary examination could help to make an accurate diagnosis. Surgical intervention play an important role in the treatment of gastric and duodenal perforation. Individual operation should be performed according to patients＇ specific situation.