胃大部切除术与单纯穿孔修补术治疗胃十二指肠溃疡穿孔疗效比较

Comparison of effect of subtotal gastrectomy and simple gastric perforation neoplasty on gastroduodenal ulcer perforation

目的评价胃大部切除术与单纯穿孔修补术治疗胃十二指肠溃疡穿孔的临床疗效。方法 86例胃十二指肠溃疡穿孔患者根据手术方法不同分为胃大部切除术组39例和单纯穿孔修补术组47例,观察比较2组患者术中出血量、手术时间、术后感染率、住院时间、肛门排气时间、术后并发症及溃疡复发率。结果单纯穿孔修补术组患者手术时间、肛门排气时间和住院时间显著短于胃大部切除术组(P<0.05),术中出血量显著少于胃大部切除术组(P<0.05),术后感染率和并发症发生率显著低于胃大部切除术组(P<0.05);腹腔镜手术组患者的手术时间、肛门排气时间和住院时间显著短于开腹手术组(P<0.05),术后感染率显著低于开腹手术组(P<0.05)。单纯穿孔修补术组与胃大部切除术组患者术后6、12个月溃疡复发率比较差异无统计学意义(P>0.05)。结论单纯穿孔修补术和胃大部切除术治疗胃十二指肠溃疡穿孔临床疗效相近,但单纯穿孔修补术手术操作简单,创伤较小;腹腔镜下修补术更具有明显的微创优势,更适用于胃十二指肠急性穿孔患者的手术治疗。

Objective To evaluate the clinical effects of subtotal gastrectomy and simple neoplasty in treatment of gas- troduodenal ulcer perforation. Methods A total of 86 patients with gastroduodenal ulcer perforation were divided into subtotal gastrectomy group （n = 39） and simple neoplasty group（ n = 47 ）. The operation time, intraoperative bleeding volume, postop- erative infection rate, hospitalization time, postoperative complications and ulcer recurrence rate were observed and compared between the two groups. Results The operation time, passage of gas by anus time and hospitalization time in simple neoplasty group were significantly shorter than those in subtotal gastrectomy group（P 〈0.05） ; the intraoperative bleeding volume,pas- sage of gas by anus time and postoperative infection rate in simple neoplasty group were significantly lower than those in subto- tal gastrectomy group（P 〈 0.05）;the postoperative complications rate of patients suffered simple neoplasty was much lower than that of patients received subtotal gastrectomy（ P 〈 0.05 ）. The operation time, passage of gas by anus time and hospitaliza- tion time of patients receiveded laparoscopic surgery were significantly shorter than those of patients received open surgery（ P 〈 O. 05 ） ; the postoperative infection rate of patients received laparoscopic surgery was lower than that of patients received open surgery（ P 〈 0.05 ）. There were no significant differences in ulcer recurrence rate at 6 and 12 months after operation between the two groups（ P 〉 0.05 ）. Conclusions The clinical efficacy of the subtotal gastrectomy and simple neoplasty for treating gastroduodenal ulcer perforation is similar, but the simple neoplasty has advantages of little trauma and simple operation. The laparoscopic surgery has more obvious advantage of minimally invasive, the laparoscopic surgery is more suitable for the treat- ment of patients with acute gastroduodenal perforation.