无症状性十二指肠溃疡并发穿孔的治疗

Treatment of perforation of asymptomatic duodenum ulcer.

目的 :探讨无症状性十二指肠溃疡并发穿孔的治疗。方法 :对 1990年以来收治的无症状性十二指肠溃疡并发穿孔 178例行保守治疗和手术治疗。其中行保守治疗 10 8例 ,行单纯缝合修补术 6 4例 ,胃大部切除术 16例 ,对 178例病人的治疗情况做回顾性分析。结果 :保守治疗 10 8例 ,治愈 98例 ,保守成功率为 90 .7%。单纯缝合修补术 6 4例 ,无手术死亡 ,平均手术时间 41m in,平均住院时间 9天。胃大部切除术 16例 ,死亡 1例 ,平均手术时间 115 m in,平均住院时间 15天 ,与单纯缝合修补术相比差异均有显著性 (P<0 .0 5 )。单纯缝合修补术后 3个月溃疡愈合率为 94% (6 0 / 6 4) ,术后 1、3、5年溃疡复发率分别为 5 % (3/ 6 0 )、8% (4 / 5 0 )、11% (5 / 45 ) ,与保守治疗组相比差异无显著性 (P>0 .0 5 )。结论 :无症状性十二指肠溃疡并发穿孔的治疗宜行保守治疗或单纯缝合修补术 ,结合正规内科治疗 ,效果满意。

Objective:To investigate treatment of perforation of asymptomatic duodenum ulcer during recent 10 years.Methods:Results of 178 cases suffering from perforated asymptomatic duodenum ulcer were retrospectively analyzed,among them 108 cases underwent non\|operative therapy,64 cases underwent simple suture closure,16 cases had subtotal gastrectomy.Results:108 cases underwent non\|operative therapy,98 cases succeeded without any complications.64 cases were performed simple suture closure.The operative and hospitalization time of suture closure was 41 minutes and 9 days,respectively.16 cases had subtotal gastrectomy,the mortality rate was 6.5%(1/16).The operative and hospitalization time was 115 minutes and 15 days,respectively.Much longer than that for the former group( P <0.05).94%(60/64)perforated ulcer healed up within 3 months after simple suture closure,the 1\|,3\|,5\|year recurrent rate of ulcer were 5%(3/60),8%(4/50),11%(5/45),respectively,which were no different from that of non\|operative therapy( P >0.05).Conclusions:The result of this study demonstrates that non\|operative treatment or simple suture closure is the main choice of treatment for perforation of asymptomatic duodenum ulcer,most patients do well with posterior standard medical treatment. [