胃十二指肠溃疡急性穿孔急诊治疗策略

Emergency Management of Acute Gastroduodenal Ulcer Perforation

目的探讨胃十二指肠溃疡急性穿孔的急诊治疗策略。方法回顾分析我院2003年3月～2007年8月62例胃十二指肠溃疡急性穿孔的临床资料。其中非手术治疗8例,急诊胃大部切除术7例,腹腔镜穿孔修补术(腹腔镜组)22例,开腹穿孔修补术(开腹组)25例,比较各方法的治疗效果。结果62例全部治愈出院,无死亡。非手术治疗8例中,无中转手术治疗,无并发症。急诊胃大部切除7例中,吻合口溃疡3例,胆汁反流性胃炎4例。在穿孔修补术47例中,腹腔镜组与开腹组手术时间分别为(71.1±15.0)min和(63.3±17.8)min(t=1.612,P=0.114),术中出血量分别为(7.4±2.6)ml和(18.0±11.8)ml(t=-4.121,P=0.000),并发症分别为0例和3例(P=0.237),术后体温>38℃分别为4例、12例(χ2=4.634,P=0.031),术后肛门排气时间分别为(35.7±6.8)h和(69.9±6.4)h(t=-17.754,P=0.000),术后住院时间分别为(6.3±0.7)d和(9.5±1.6)d(t=-8.670,P=0.000)。结论胃十二指肠溃疡急性穿孔的急诊治疗中,腹腔镜下修补是安全有效的,应作为首选。而非手术治疗和急诊胃大部切除术是对胃十二指肠溃疡急性穿孔急诊治疗的有效补充。

Objective To investigate the strategies for the emergency management of acute gastroduodenal ulcer perforation. Methods The clinical data of 62 patients with acute gastroduodenal ulcer perforation, who were admitted to our hospital between March 2003 and August 2007 were analyzed retrospectively. Among the cases, 8 received non-surgical treatments, 7 underwent emergency subtotal gastrectomy, 22 were treated by laparoseopic repair （laparoscopic group） , and 25 were repaired by open surgery （open group）. The outcomes of the different methods were compared. Results All of our patients were cured. None of the 8 patients, who received non-surgical treatments, was converted to surgery or developed complications. In the 7 cases of emergency subtotal gastrectomy, 3 had anastomotic ulcer, and 4 suffered from bile regurgitation gastritis. Among the other 47 patients, who received perforation repair, the mean operation time was （71. 1 ± 15.0） rain and （63.3± 17.8） min respectively for the laparoscopic and open groups （t=1.612, P=0.114）, mean intraoperative blood loss was （7.4±2.6） ml and （18.0±11.8） ml （t= -4. 121, P = 0. 000） , mean postoperative hospital stay was （6.3 ±0.7 ） d and （ 9.5 ± 1.6 ） days （ t = - 8. 670, P =0. 000） , and mean recovery time of bowel function was （35.7±6.8） h and （69.9 ＋6.4） h （t = -17.754, P=0.000）. In the laparoseopie group, none of the patients had postoperative complications, only 4 patients had high body temperature （ 〉 38℃ ） , while in the open group, 3 patients showed complications, 12 had the body temperature over 38℃ Conclusions Laparoscopic repair, which is feasible and safety for acute gastroduodenal ulcer perforation, should be the first choice in emergency, while non-surgical treatments and emergency subtotal gastrectomy can be two alternatives.