消化道溃疡穿孔85例诊治体会

Diagnosis and treatment of digestive tract perforation in 85 cases

目的探讨消化道溃疡穿孔最佳的诊治途径与方法。方法回顾性分析2006年1月至2011年12月安泽县人民医院外科收治的85例消化道溃疡穿孔患者的临床病理及随访资料。结果85例患者均经手术治疗，首次就诊最主要的症状：腹痛、上腹部压痛、反跳痛58例（68．2％），恶心、呕吐伴贫血、便血15例（17．6％），休克9例（10．6％），发热3例（3．5％）。立位腹部平片示膈下游离气体68例（80％）。术后诊断十二指肠溃疡穿孔23例（27％），胃溃疡穿孔57例（67％），胃癌穿孔5例（5．9％）。其中实施胃十二指肠穿孔修补或溃疡切除术58例（68．2％），胃大部切除术23例（27．1％），胃癌根治术4例（4．7％）。术后溃疡复发率：单纯修补术15例（26．8％）中死亡2例；胃大部切除术4例（14．8％）中死亡1例，两组复发率比较差异有统计学意义（x2=4．078，P〈0．05）。结论上消化道穿孔临床最主要的症状为上腹部压痛、反跳痛；休克症状多发生在发病24h后。立位腹部平片示膈下游离气体为主要的诊断依据。穿孔单纯修补或溃疡切除修补术联合抑酸药可降低复发率，胃大部切除术为根治性的治疗方法。

Objective To investigate the best way of diagnosing and treating the digestive tract perforation. Methods Clinical pathological and follow-up information of patients in Anze county people＇ s hospital from January 2006 to December 2011 were collected. Statistical analysis was conducted using the SPSS 17.0 software. Results All 85 patients were received operations. The main symptoms for medical in the first time： intense abdominal pain, tenderness, and rebound teneer-ness 58 cases （68.2%）. Nausea and vomiting with anemia or bloody stool in 15 cases（ 17.6% ）, shock in 9 cases （ 10. 6% ） ,fever in 3 cases（3.5% ）. Three-dimensional abdominal plain X-ray with free air occured in 68 cases. Duodenal ulcer perforation in 23 cases （27 % ）, gastric ulcer perforation in 57 cases （67 % ）, gastric cancer perforation in 5 cases（5.9% ）after postoperative pathology. The patients who received gastroduodenal perforation repair or ulcer resection were 58 cases （68.2%）, who received subtotal gastrectomy were 23 cases（27. 1% ）, who received radical surgery for gastric cancer were 4 cases（4. 7% ）. Postoperative ulcer recurrence rate： perforation repair or ulcer resection with 15 cases （26. 8% ）, 2 cases died, subtotal gastrectomy with 4 cases（ 14. 8% ）, 1 cases died. The recurrence rate had statistical significance between two groups （X2 = 4. 078, P 〈 0. 05 ）. Conclusions The main symptoms of upper digestive tract perforation patients are, tenderness, and rebound tender-nsee. Shock signs occurs in the 24 hours later after perforation. X-ray with free air should be concerned. The simple perforation repair or ulcer ex- cision repair Combined with acia inhibitory drugs can decrease the recurrence rate, subtotal gastrectomy is the radical therapy.