消化性溃疡穿孔治疗方法的选择

Selection of Surgical Procedures for perforated gastric ulcer or duodenal ulcer

目的探讨损伤控制在胃十二指肠溃疡穿孔手术治疗中的应用。根据损伤控制理论合理选择胃十二指肠溃疡穿孔的手术方式。方法回顾性分析我院1996年1月-2006年12月收治的胃十二指肠溃疡穿孔98例的临床资料。结果行单纯溃疡修补术84例，治愈81例，死亡3例；行胃大部切除术12例，治愈11例，死亡1例；保守治疗2例，均治愈。结论胃十二指肠溃疡穿孔病人诊断一旦明确，在损伤控制理论的指导下，在进行体液复苏，抗感染，纠正水、电解质和酸碱平衡紊乱的前提下，以抢救生命为首要治疗目的，选择损伤小、简单、快捷且能阻断病情发展的穿孔修补手术，术后进行规范的抗溃疡及根除幽门螺杆菌治疗，能有效治愈溃疡，预防复发。

Objective To explore the application of technique of damage control in treatment of the perforated gastric ulcer or duodenal ulcer and select reasonable surgical procedures for gastric ulcer or duodenal ulcer perforation according to the theory of damage control. Methods Retrospective analysis was made on the clinical data of 98 cases of gastric ulcer or duodenal ulcer performation from Jan. 1996 to Dec. 2006. Results Of 84 cases,81 were cured and 3 died after the operation of perforation repair. Of 12 cases, 11 were cured and 1 died after the operation of partial gastrectomy. And the 3 cases subject to conservative treatment were cured. Conclusion The operation of perforation repair is simple and effective emergency operation for the patients with perforated gastric ulcer or duodenal ulcer. Shock, infection, disorder of fluid and electrolyte and acid-base balance should be corrected. The standard treatment of anti-ulcer and eradicating the Hp after operation can effectively cure the ulcer and prevent recurrence.