B超引导下穿刺引流治疗老年胃十二指肠溃疡急性穿孔患者的疗效评价

Evaluation of Ultrasound Guided Percutaneous Drainage for Acute Perforation of Gastroduodenal Ulcer in Elderly Patients

目的探讨B超引导下穿刺引流治疗老年胃十二指肠溃疡急性穿孔患者的应用价值。方法对我院2004年1月至2009年10月期间86例老年(≥65岁)胃十二指肠溃疡急性穿孔患者的临床资料进行回顾性分析,其中行穿刺引流治疗21例(引流组),行剖腹探查治疗65例(开腹组)。结果引流组21例全部治愈出院,无手术并发症;术后1个月15例行胃镜复查,其中12例溃疡愈合,3例溃疡好转。开腹组中63例治愈出院,2例死亡,治愈率与引流组比较差异无统计学意义(P>0.05);出现手术并发症11例,明显多于引流组(P<0.05);术后1个月45例行胃镜复查,其中38例溃疡愈合,7例溃疡好转。结论对于老年胃十二指肠溃疡急性穿孔患者,如无法耐受手术,B超引导下穿刺引流应为一种简单、安全、有效的治疗方法。

Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients.Methods The clinical features,treatments,and the curative effects of 86elderly cases（≥65years）of acute perforation of gastroduodenal ulcer in our hospital between January 2004and October 2009were retrospectively analyzed.Twenty-one cases were treated by ultrasound guided percutaneous drainage（drainage group）,and 65cases were treated by exploring operation（operation group）.Results Drainage group was cured and had no complications.In 15patients which accepted recheck one month after drainage,gastroscope showed the ulcer healed in 12cases,and improved in 3cases.In operation group,63cases were cured and 2cases died.Compared with the drainage group,there was no significant difference in cure rate（P0.05）.However,11patients had operative complications in operation group,which was significantly more than that in the drainage group（P0.05）.In 45patients which accepted recheck one month after operation,gastroscope showed the ulcer healed in 38cases,and improved in 7cases.Conclusion For elderly patients with acute perforation of gastroduodenal ulcer,if the patients do not fit for exploring operation,ultrasound guided percutaneous drainage is proved to be a simple,safe,and effective means.