上消化道穿孔外科手术治疗与保守治疗的临床疗效对比分析

Comparative analysis of clinical effects of surgical therapy and conserva-tive therapy of upper digestive tract perforation

目的探讨在上消化道穿孔病例的临床诊治中，保守治疗与手术治疗的具体治疗效果。从而为临床治疗方法的选用提供重要参考依据。方法选用我院于2014年1月～2015年10月间收治的上消化道穿孔患者110例．按照穿孔类型将其分为空腹穿孔组和餐后穿孔组，其中空腹穿孔组患者54例，对其予以保守治疗。餐后穿孔组患者56例，对其予以外科手术治疗。治疗结束后对两组患者的临床疗效、住院时间、并发症发生率等相关指标予以对比分析。结果治疗后，餐后穿孔组患者治疗总有效率为98．21％（55／56），明显高于空腹穿孔组（88．89％），差异具有统计学意义（P〈0．05）；餐后穿孔组患者术后并发症2例，发生率为3．57％，明显低于空腹穿孔组（11．11％）。差异具有统计学意义（P〈0．05）；餐后穿孔组患者的平均住院时间为（13．3±2．2）d，与空腹穿孔组患者（8．5±1．4）d比较，明显长于后者。结论在上消化道穿孔病症的临床诊治中，通过采用外科手术治疗的方法，效果显著，安全系数较高，能够有效降低术后并发症发生几率，提高患者的生活质量。帮助患者早日康复，因而值得在临床上推广和应用。但由于手术治疗的方式所需的住院时间较长，对患者的经济能力造成一定压力，因此在选用具体治疗方法时应当充分尊重患者及其家属的意愿。

Objective To explore the therapeutic effects of conservative therapy and surgical therapy in the clinical di- agnosis and treatment of upper digestive tract perforation, so as to provide important references for the selection of clin- ical treatment methods. Methods 110 patients with upper digestive tract perforation who were admitted to our hospital from January 2014 to October 2015 were selected. They were assigned to the fasting perforation group and postprandial perforation group according to the type of perforation. There were 54 patients in the fasting perforation group, and con- servative therapy was applied to the group. There were 56 patients in the postprandial perforation group, and surgery was applied to the group. Related indicators such as clinical therapeutic effects, length of stay and incidence of complications after the treatment were compared and analyzed in the two groups of patients. Results After the treatment, the total effective rate in the postprandial perforation group was 98.21% （55/56）, significantly higher than that in the fasting perforation group（88.89%）. The difference was statistically significant（P〈0.05）; there were 2 cases of postoperative complications in the postprandial perforation group, and the incidence rate was 3.57%, significantly lower than that in the fasting perforation group （11.11%）. The difference was statistically significant （P〈0.05）; the average length of stay was （13.3±2.2） d in the postprandial perforation group, significantly longer than that of （8.5±1.4） d in the fasting perforation group. Conclusion In the clinical diagnosis and treatment of upper digestive tract perforation, the surgical method has evident effects and higher safety, and is able to effective reduce the incidence rate of postoperative complications, improve patients＇ life quality and promote patients＇ early recovery, which is worthy of clinical promotion and application. However, due to longer length of stay by surgical method, it may exert certain pressure on patients＇ financial capability. Therefore, patients＇ and family＇s wiliness should be fully respected in the selection of therapeutic methods.