单纯修补和胃大部切除在胃溃疡穿孔患者中的应用效果评价

Evaluation of Curative Effect of Simple Repair and Subtotal Distal Gastrectomy in Treating Patients with Gastric Perforation

目的探讨单纯修补和胃大部切除在胃溃疡穿孔患者中的应用效果。方法从南阳医学高等专科学校第一附属医院于2009年2月至2010年2月收治的胃溃疡穿孔患者中选取150例,其中采取单纯修补术进行治疗的患者75例(单纯修补组),采取胃大部切除治疗的患者75例(胃大部切除组),回顾性分析两组患者的手术时间、术后疼痛情况、肠功能恢复时间、住院时间、术后并发症,随访记录患者术后恢复及溃疡复发情况。结果单纯修补组患者手术时间(43.8±5.2)min、肠功能恢复时间(3.2±1.3)d、住院时间(8.1±1.7)d,胃大部切除组患者手术时间(154.3±23.9)min、肠功能恢复时间(5.2±2.2)d、住院时间(13.5±5.2)d,单纯修补组手术时间、肠功能恢复时间、住院时间均较胃大部切除组短,差异有统计学意义(P<0.05);75例单纯修补组术后并发症发生率为8%,75例胃大部切除组为20%,胃大部切除组术后并发症情况显著优于单纯修补组(χ2=4.49,P<0.05);Visick分级方面,胃大部切除组显著优于单纯修补组(Z=2.224,P=0.026)。结论单纯修补和胃大部切除各有其优缺点,临床上应综合考虑,选择合适的手术方式。

Objective To evaluate the efficacy oti simple repair and subtotal distal gastrectomy in trea- ting patients with gastric perforation. Methods From Feb. 2009 to Feb. 2010,150 patients who were diag- nosed with gastric perforation in the First Affiliated Hospital of Nanyang Medical College were selected,75 of them were treated with simple repair and the other 75 were treated with subtotal distal gastrectomy, and time of operation, pain after operation, time of bowel function recovery, hospital stays and postoperative complica- tions, recovery and recurrence of ulcers during follow-up were retrospectively analyzed. Results The time of operation, time of bowel function recovery, hospital stays of simple repair group were （ 43.8 ＋ 5.2 ） min, （5.2 ~ 1.3 ） d and （8.1 ＋ 1.7 ） d, while that of subtotal gastrectomy group were （154.3 ~ 23.9 ） min, （5.2 ~ 2.2 ） d and （13.5 ~ 5.2 ） d, there were significant differences between the two groups （P 〈 0.05 ） ; the subtotal gastrectomy group had a higher complication rate（ 20% ） than the simple repair group（ 8% ） （ X2 = 4.49,P 〈 0.05 ） ; in Vislck classification, patients in subtotal gastrectomy group was much better than thee simple repair group （ Z = 2. 224, P = O. 026 ）. Conclusion Simple repair of perforation and subtotal distal gastreetomy both have own advantages and disadvantages in treating patients with gastric perforation, comprehensive consideration should be done in clinical to choose the appropriate operation method.