老年消化性溃疡232例临床分析

Clinical Analysis of 232 Elderly Patients with Peptic Ulcer

目的探讨老年消化性溃疡的临床及内镜下病变特点。方法回顾性分析我院2006年3月~2010年6月经胃镜及病理检查确诊的老年消化性溃疡232例（老年组）及中青年消化性溃疡784例（中青年组）的临床资料,对两组的临床及内镜下病变特点进行分析比较。结果老年组非甾体类药应用率及幽门螺杆菌（Hp）感染率分别为46.1%、56.9%,中青年组分别为6.9%、77.9%,差异均有统计学意义（P〈0.01）;老年组节律性上腹痛、非特异性症状、无症状、伴随疾病发生率依次为18.5%、45.7%、35.8%及59.9%,中青年组依次为67.5%、20.8%、11.7%和20.0%,差异均有统计学意义（P〈0.01）;老年组十二指肠球部溃疡、胃窦、幽门口及胃角部溃疡、胃体及胃底部溃疡及溃疡直径≥2.0 cm的发生率依次为31.5%、33.6%、28.9%和11.2%,中青年组依次为58.4%、19.9%、9.9%及3.1%,差异均有统计学意义（P〈0.01）;老年组出血、梗阻、穿孔发生率及并发症总发生率分别为43.5%、9.1%、2.2%、54.7%,中青年组依次为28.1%、3.1%、5.0%、36.1%,差异均有统计学意义（P〈0.01）。结论老年消化性溃疡发病危险因素多,临床表现不典型,并发症多,溃疡面积大,发生部位易向高位转移,应引起临床医生高度重视。

Objective To explore the clinical and gastroscopic characteristics of elderly patients with peptic ulcer.Methods 232 elderly patients with peptic ulcer（elderly group） and 784 young patients with peptic ulcer（young group） confirmed by gastroscopy and pathological examination in our hospital during March 2006 and June 2010 were retrospectively analyzed and the clinical and gastroscopic characteristics between the two groups were compared.Results The non-steroidal anti-inflammatory drugs applied rate and Hp positive rate in elderly group were 46.1% and 56.9% respectively,but were 6.9% and 77.9% in the young group,the difference was statistically significant（P0.01）;the incidence of rhythmic epigastric pain,Non-specific symptoms,no symptom and accompanied diseases in the elderly group were 18.5%,45.7%,35.8% and 59.9% respectively,but were 67.5%,20.8%,11.7% and 20.0% in the young group,and the difference was statistically significant（P0.01）;in the elderly group there were duodenal ampulla ulcer（31.5%）,gastric antrum pylorus and gastric angle ulcer（33.6%）,gastric corpus and gastric fundus ulcer（28.9%）,but were 58.4%,19.9% and 9.9% in the young group respectively;the incidence of ulcer diameter longer than 2 cm in the elderly group was 11.2%,while 3.1% in the young group,all the difference was statistically significant（P0.01）;the incidences of bleeding,obstruction perforation and total complication in elderly group were 43.5%,9.1%,2.2%,54.7% respectively,while they were 28.1%,3.1%,5.0% and 36.1% in the young group,the difference was statistically significant（P0.01）.Conclusion There are many risk factors in elder patients with peptic ulcer.Their clinical manifestations are atypical but with multiple complications,elevatus and large areal ulcer and physicians should pay close attention.