单纯修补或加PCV后清除Hp治疗十二指肠溃疡穿孔

Clinical Evaluation of Simple Repair or Plus PCV Followed by Removal of Helicobacter Pylori in Patients with Perforated Duodenal Ulcer

目的：评估十二指肠溃疡穿孔行单纯修补或加行壁细胞迷切（ＰＣＶ）术后常规清除幽门螺杆菌（Ｈｐ）的疗效。方法：１９９４年来，我院收治十二指肠溃疡穿孔５１例，其中单纯修补４１例，修补加ＰＣＶ１０例。术后均常规予清除Ｈｐ治疗，并对术后恢复及溃疡复发情况作一回顾性分析。结果：经２年以上随访，单纯修补或加ＰＣＶ术后再常规清除Ｈｐ，溃疡复发率和再手术率均明显降低。修补加ＰＣＶ组疗效显著优于单纯修补组（Ｐ＜０．０５）；单纯修补组中，急性溃疡穿孔病例的疗效显著优于慢性溃疡穿孔（Ｐ＜０．０５）。结论：单纯修补术后再清除Ｈｐ可作为急性溃疡穿孔的理想治疗方案；修补加ＰＣＶ术后再清除Ｈｐ治疗慢性溃疡穿孔可获良好根治溃疡效果。

Objective: To evaluate the therapeutic effects of simple repair or plus parietal cell vagotomy(PCV), followed by removal of Helicobacter pylori(Hp) in patients with perforated pyloroduodenal ulcer. Methods: During the period from 1994 to 1999, fifty-one patients suffering from perforated duode- nal ulcer were admitted to our hospital. All cases underwent simple repair, among them, 10 cases underwent PCV simultaneously. All patients were treated by removal of Hp after operation. The clinical data were retropspectively analyzed. Results: The patients were followed up over 2 years. The recu-rrent rate of digestive ulcer and reoperative rate were dramatically decreased in both two groups. The therapeutic effect of acute ulcer cases were much better than that of chronic ulcer cases in simple repair group (P<0.05). Conclusions: Simple repair followed by removal of Hp should be served as the first choice for the cases of perforated acute ulcer. Repair plus PCV followed by removal of Hp might gain a good result.