十二指肠溃疡穿孔单纯缝合修补术的临床疗效观察

Clinical evaluation of the effects of suture closure for perforated duodenal ucler

目的观察十二指肠溃疡穿孔行单纯缝合修补术的疗效。方法对１９９２年以来收治的十二指肠溃疡穿孔１１８例病人行手术治疗。其中行单纯缝合修补术８４例；胃大部分切除术１９例，高选择性迷走神经切除加修补术１５例。对１１８例病人的手术及术后情况做回顾性分析。结果单纯缝合修补无手术死亡，平均手术时间４２ｍｉｎ，平均住院时间９天，均显著短于后二者（Ｐ＜００１）。术后３个月溃疡愈合率为７９／８３（９５％），术后１、３、５年溃疡复发率分别为１１％（９／８３）、２２％（１２／５４）和２５％（４／１６），与高选择性迷走神经切除加修补相比，无显著差异（Ｐ＞００５），远期并发症发生率为８％（７／８３），亦低于后二者（Ｐ＜００５）。病史长短和术前治疗对术后溃疡愈合与复发有一定影响，而与溃疡穿孔的大小无关。结论十二指肠溃疡穿孔单纯缝合修补操作简单、安全、并发症少，术后结合正规内科治疗。

Objective To evaluate the therapeutic effect of suture closure for perforated duodenal ucler during recent 5 years. Methods Results of 118 cases suffering from perforated duodenal ucler were summarized,among them 84 cases underwent simple suture closure, 19 cases had subtotal gastrectomy and 15 patients with ultraselective vagotomy plus suture closure.Results The operative and hospitalization time of suture closure was 42 minutes and 8 65 days,respectively,much shorter than that for the other two groups ( P <0 01).95% (79/83) perforated uclers healed up within 3 months after simple suture closure, the 1-, 3- and 5-year recurrent rate of ucler were 11% (9/83), 22% (12/54) and 25% (4/16) respectively,which were no diffrent from that of ultraselective vagotomy plus suture closure ( P >0 05). The long term postoperative complication rate, reoperative rate and maimed rate were 8% ( P <0 05),11% ( P >0 05) and 3 6% ( P >0 05) respectively,compared with those undergoing gastrectomy or vagotomy.The duration of illness and the preoperative medical treatment could affect the recurrent and healing rate somehow ( P <0 05), while the size of perforated ucler wasn't significant influencing factor ( P >0 05).Conclusions The result of this study demostrates that suture closure for perforated duodenal ucler is simple, safe and with less complications, most patients do well with postoperative standard medical treatment.