良性胃十二指肠溃疡急性穿孔不同手术方法的疗效比较

Comparison of the therapeutic effects on different surgical procedures for perforated gastroduodenal ulcer

目的探讨良性胃十二指肠溃疡急性穿孔不同手术方式治疗的临床价值。方法对我院1993年1月～2007年6月收治的128例胃十二指肠溃疡急性穿孔分为单纯穿孔修补术加抑酸、根除幽门螺杆菌(第一组)、穿孔修补加扩大壁细胞迷走神经切断术(第二组)、胃大部切除(第三组)进行疗效比较。结果所有病例治愈出院,随访6～120个月,三组的疗效按改良Visick分级评分标准Ⅰ、Ⅱ级分别为84.4%、88.1%、74%,溃疡复发率分别为6.7%、4.8%、7.4%,术后再次穿孔率均为零。χ2均﹤χ20.05(1),P>0.05,三组差异无显著性。结论消化性溃疡穿孔修补加抑酸、根除幽门螺杆菌治疗,操作简单、创伤小、并发症少、远期疗效好,可以作为胃十二指肠溃疡穿孔治疗的首选方式。

Objective To investigate the clinical value of different surgical procedures for acute perforated gastro-duodenal ulcer. Methods From January 1993 to June 2007, the clinical data of 128 cases with acute perforated gastro-duodenal ulcer by the simple suture and eradicating the HP and the extended parietal cell vagotomy and the subtotal gastrectomy were compared on the therapeutic effects. Results In this group, All cases were cured to discharge from hospital. The follow-up time was 6 to 120 months. According to modified Visick grading score criteria, the visick Ⅰ and Ⅱ grading of group 1,2 and 3 were in 84.4%, 88.1% and 74% respectively. The recurrence rates wrere in 6.7%,4.8% and 7.4% respectively. The re-perforation rate was zero in all cases. χ^2 was 〈 χ^2 0.05 （P〉0.05）. These differenes were not statistical significance. Conclusion Perforated peptic ulcer repair plus antiaeid eradicating HP treatment possess simple manipulation, less trouma, few postoperative complications and a good longerm therapeutic efficacy. It would serve as first choice for the treatment of perforated gastro-duodenal ulcer.