胃大部分切除术与单纯修补术治疗急性胃穿孔的疗效比较

Comparison of Curative Effect between Major Gastrectomy and Hernia Repair on Acute Gastric Perforation

目的探讨胃大部分切除术与单纯修补术治疗急性胃穿孔的疗效比较。方法方便选择2016年3月—2018年1月收治的90例急性胃穿孔患者,据术式分组。对照组开展胃大部分切除术治疗,观察组行单纯修补术治疗。比较两组急性胃穿孔手术治疗效果;手术全程所需的时间、手术过程出血量、平均住院时间、术后开始进食流食时间;手术前后患者生活质量状况QOL评分;手术并发症发生率,手术后复发率。结果观察组急性胃穿孔手术治疗效果45例(100.00%)高于对照组35例(77.78%)(χ2=11.250 0,P<0.05);观察组手术全程所需的时间、手术过程出血量、平均住院时间、术后开始进食流食时间(42.12±12.13)min、(85.61±4.13)m L、(6.27±0.42)d、(24.25±3.13)h优于对照组(t=9.263、9.127、8.734、10.114,P<0.05);手术后观察组生活质量状况QOL评分优于对照组(P<0.05)。观察组手术并发症发生率4例(8.89%)少于对照组11例(24.44%)(χ2=3.920 0,P<0.05)。对照组复发率2.22%低于观察组20.00%(χ2=3.844,P<0.05)。结论急性胃穿孔患者行单纯修补术疗效肯定,可有效去除病变,减少并发症,改善生存质量,减少术中创伤,缩短手术时间和住院时间,术后胃肠道恢复快,近期效果肯定,但远期复发率高于胃大部分切除的患者。

Objective To compare the curative effects of gastrectomy and hernia repair on acute gastric perforation. Methods 90 patients with acute gastric perforation from March 2016 to January 2018 were convenient selected according to surgical method. The control group underwent major gastrectomy and the observation group underwent simple repair. The effectof surgical treatment of acute gastric perforation was compared between the two groups; the time required for the entire operation, the amount of blood loss during the operation, the average length of stay, and the time of starting a liquid diet afterthe operation; the quality of life status, QOL scores; and the incidence of surgical complications, the recurrence rate aftersurgery of patients before and after surgery were compared. Results The therapeutic effect of acute gastric perforation in observation group was 45 cases（100.00%） higher than that of control group 35 cases （77.78%） （X^2=11.250 0, P〈0.05）. The timerequired for the entire operation in the observation group, the amount of bleeding during the operation, the average length ofstay, postoperative results showed that （42.12±12.13）min, （85.61±4.13）mL, （6.27±0.42）d, and （24.25±3.13）h were betterthan the control group at the start of feeding and eating （t=9.263,9.121,8.734,10.114,P〈0.05）; The QOL score was betterthan that of the control group（P〈0.05）. The incidence rate of surgical complications in the observation group 4 cases（8.89%）was less than the control group 11 cases（24.44%）（X^2= 3.920 0, P〈0.05）. The recurrence rate in the control group was 2.22%lower than that in the observation group 20.00%（X^2=3.844, P〈0.05）. Conclusion The curative effect of the repair of acutegastric perforation is positive, it can effectively remove the lesions, reduce the complications, improve the quality of life, reduce intraoperative trauma, shorten the operation time and length of stay, postoperative gastrointestinal tract recovery, the recent results are positive, but the long-term recurrence rate is higher than that of patients with a major part of the stomach.