幽门梗阻的手术治疗体会(附55例报道)

Experience of operation treatment in pyloric obstruction(55 cases reported)

目的分析幽门梗阻患者的临床特点和手术效果,以指导诊治及判断预后。方法对55例幽门梗阻患者的临床特点和手术预后进行回顾性分析。良性病变引起的幽门梗阻25例（45.5%）,恶性病变引起的幽门梗阻30例（54.5%）,行胃大部分切除术20例（36.4%）,胃癌根治术3例（5.5%）,姑息切除19例（34.5%）,胃空肠吻合6例（10.9%）,空肠造口2例（3.6%）。结果 55例中临床治愈28例,治愈率为51%,均为良性溃疡病,异物及早期胃癌,术后随访2-5年疗效满意。好转24例（43.5%）,以中、晚期胃癌为主。死亡3例（5.5%）,均为晚期胃癌,其中1例术后因多器官功能衰竭死亡,2例自动出院于3-6个月内全身衰竭、严重消化功能障碍等原因死亡。结论良性病变引起的幽门梗阻手术后预后较好。胃癌并幽门梗阻绝大部分为癌症晚期,宜早期手术,合理治疗。对晚期病例以减轻病人痛苦改善全身状况和提高生存质量为主。

Aim To analyse the clinical characteristic and operation effect of pyloric obstruction,and give a better guide to the diagnosis,therapy and judgement of prognosis for the patients suffering from pyloric obstruction.Methods We summarized 55 cases suffering from pyloric obstruction and studied clinical characteristic and operation effect.There were 25 cases suffering from pyloric obstruction because of benign lesion,and 30 cases were of malignant disease.In this group,patients suffering from pyloric obstruction were performed with subtotal gastrectimy（36.4%）,radical gastrectomy（5.5%）,palliative surgery（34.5%）,gastrojejunostomy（10.9%） and jejunostomy（3.6%）,respectively.Results After 2~5 years follow-up,clinical curing rate was 51%,28 patients of this group were suffered from nonmalignant canker,corpus alienum and early gastric cancer.There were 24 cases（43.5%） improved with advanced carcinoma of stomach.Three cases died from late gastric cancer,one case died of multiple organ failure,the other two cases was of depletion and severe digestive funcitional disturbance in 3-6 months after initiative discharge.Conclusions The prognosis of pyloric obstruction postop is better in benign lesion.Gastric cancer with pyloric obstruction is advanced carcinoma,we ought to do our best to ablate appeasable operation which might delay patient＇s life.We ought to operate as quickly as possible.It is important to lighten the suffering,to improve the condition of all over the body and to elevate quality of life for advanced carcinoma of stomach.