成人上消化道穿孔手术治疗的临床分析

Clinical Analysis of Surgical Treatment of Upper Gastrointestinal Perforation in Adults

目的:分析成人上消化道穿孔手术治疗情况。方法:选择2014年1月-2021年12月杭州市萧山区第一人民医院收治的急性上消化道穿孔患者209例为研究对象。分析患者的发病时间、手术方式、术中所见、住院时间、腹腔细菌培养结果等信息。结果:胃穿孔病例数多于十二指肠穿孔;男性患者较多;腹腔镜手术占比近5年明显提高;革兰阳性菌多见于早期腹腔感染,革兰阴性菌感染在发病后期常见。结论:在急性上消化道穿孔中,胃穿孔发生率高于十二指肠穿孔;男性患者多于女性;穿孔部位与年龄、性别无明显相关性;腹腔镜手术日渐普及;发病早期以革兰阳性菌与真菌为主的腹腔感染多见,革兰阴性菌随病程延长成为后期腹腔感染的常见菌种。

Objective: To analyze the effect of surgical treatment of upper gastrointestinal perforation in adults. Methods: A total of209 patients with upper gastrointestinal perforation treated in the First People’s Hospital of Xiaoshan District in Hangzhou from January 2014 to December 2021 were selected as the study subjects. The time of onset, operation method, intraoperative findings,length of hospital stay, peritoneal bacterial culture results and other information of patients were analyzed. Results: In the patients with acute upper gastrointestinal perforation, the incidence of gastric perforation was higher than that of duodenum perforation,and the incidence in men was higher than that in women. There was no significant correlation between the location of perforation and the age and gender;Laparoscopic surgery has become the preferred approach of surgical treatment;Gram-positive bacteria are the most common in abdominal infection;The age, gender, location and diameter of perforation have no correlation with the bacterial type of abdominal infection;In the early onset stage, the abdominal infection caused by Gram-positive bacteria and fungi is the most common, while the Gram-negative bacteria become the common strains of abdominal infection in the later stage along with the prolonging course of the disease.