胃大部切除术与单纯修补术治疗急性胃穿孔的效果比较

Comparison of effect of subtotal gastrectomy and simple closure operation treatment of acute gastric perforation

目的探讨胃大部切除术与单纯修补术治疗急性胃穿孔的临床效果并进行比较。方法选择我院2013年1月～2014年1月所收治急性胃穿孔患者60例,随机分为切除组与修补组各30例,切除组给予胃大部切除手术进行治疗,修补组给予单纯修补术进行治疗,比较两组患者的术中出血量、手术时间、术后并发症、住院时间及复发率等。结果切除组患者手术时间为（135.3±14.5）min,术中出血量为（139.7±16.4）m L,住院时间为（16.4±3.3）d,并发症发生率为33.33%,修补组手术时间为（47.2±6.6）min,术中出血量为（82.6±12.3）m L,住院时间为（9.1±2.8）d,并发症发生率为6.67%,两组各数据比较差异有统计学意义（P〈0.05）;切除组术后1～18个月总复发例数明显少于修补组,且4～6个月、13～18个月其复发率明显低于修补组,差异有统计学意义（P〈0.05）。结论对于急性胃穿孔的患者来说,采用胃大部切除及单纯修补术均是有效的方法,但两者各有优缺点,胃大部切除术治疗彻底,复发率低,单纯修补术安全性高,术中出血少,手术时间及住院时间短,应根据患者的实际情况选择合理的治疗方案。

Objective To study and compare the clinical effect of subtotal gastrectomy and simple closure operation in the treatment of acute gastric perforation. Methods 60 patients with acute gastric perforation who were treated in our hospital from January 2013 to January 2014 were randomly divided into resection group treated with subtotal gastrectomy, and neoplasty group treated with simple closure operation, with 30 cases in each group. To compare the intraoperative blood loss, the operation time, the postoperative complication, the hospitalization time and the recurrence rate and so on between the two groups. Results The operation time, the intraoperative blood loss, the hospitalization time and the recurrence rate were（135.3±14.5）min,（139.7±16.4）m L,（16.4±3.3）d and 33.33% in resection group, while which were（47.2±6.6）min,（82.6±12.3）m L,（9.1±2.8）d and 6.67% in neoplasty group, the difference had statistical significance（P〈0.05）. The total recurrent numbers were less in resection group than which in neoplasty group in（1-18）months, the recurrence rate was obviously lower in resection group than which in neoplasty group in（4-6） months and（13-18） months, the difference had statistical significance（P〈0.05）. Conclusion Subtotal gastrectomy which has complete cure and lower recurrence rate and simple closure operation which has high safety, less of intraoperative blood loss, shorter operation time and shorter hospitalization time in the treatment of acute gastric perforation are all effective methods, has its respective advantages and disadvantages, should be reasonably selected according to the actual situation of patients.