胃大部分切除术与穿孔修补术治疗急性胃穿孔的效果比较

Comparison of the effects of subtotal gastrectomy and perforation repair in the treatment of acute gastric perforation

目的比较胃大部分切除术与穿孔修补术治疗急性胃穿孔的效果。方法选取2018年1月至2020年12月我院收治的100例急性胃穿孔患者为研究对象,根据手术方式不同将其分为修补组(50例,穿孔修补术治疗)和切除组(50例,胃大部分切除术治疗)。比较两组的治疗效果。结果修补组的治疗总有效率低于切除组(P<0.05)。修补组的手术时长、术后卧床时长、术后排气时间、住院时长短于切除组,术中出血量少于切除组,出院时视觉模拟评分法(VAS)评分低于切除组(P<0.05)。修补组的并发症总发生率低于切除组(P<0.05)。修补组术后1年的总复发率高于切除组(P<0.05)。术后7 d,修补组的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、去甲肾上腺素(NE)、皮质醇(Cor)、前列腺素E_(2)(PGE_(2))、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PAI-1)及D-二聚体(D-D)水平低于切除组,胃泌素水平高于切除组(P<0.05)。修补组术后1个月的5 h胃排空率、胃电图正常率高于切除组(P<0.05)。结论胃大部分切除术与穿孔修补术在急性胃穿孔治疗中均具有较高应用价值,且各具优点。穿孔修补术可缩短患者术后恢复时间,降低并发症发生风险低;胃大部分切除术疗效更佳且复发率低。在临床中,应根据患者具体情况选择合适术式。

Objective To compare the effects of subtotal gastrectomy and perforation repair in the treatment of acute gastric perforation.Methods A total of 100 patients with acute gastric perforation admitted in our hospital from January 2018 to December 2020 were selected as the research objects.According to different surgical methods,the patients were divided into repair group(50 cases,perforation repair treatment)and resection group(50 cases,subtotal gastrectomy treatment).The therapeutic effects of the two groups were compared.Results The total effective rate of treatment in the repair group was lower than that in the resection group(P<0.05).The operation time,postoperative bed time,postoperative exhaust time and hospitalization time of the repair group were shorter than those of the resection group,the intraoperative blood loss was less than that of the resection group,and the Visual Analogue Score(VAS)score at discharge was lower than that of the resection group(P<0.05).The total incidence of complications in the repair group was lower than that in the resection group(P<0.05).The total recurrence rate at 1 year after operation of the repair group was higher than that of the resection group(P<0.05).At 7 d after operation,the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),norepinephrine(NE),cortisol(Cor),prostaglandin E_(2)(PGE_(2)),tissue-type plasminogen activator(t-PA),plus-minogen activator inhibitor-1(PAI-1)and D-dimer(D-D)in the repair group were lower than those in the resection group,and the gastrin level was higher than that in the resection group(P<0.05).The 5 h gastric emptying rate and normal rate of electrogastrogram at 1 month after operation in the repair group were higher than those in the resection group(P<0.05).Conclusion Both subtotal gastrectomy and perforation repair have high application value in the treatment of acute gastric perforation,and each has its own advantages.Perforation repair can shorten the postoperative recovery time and reduce the risk of complications,subtotal gastrectomy has better efficacy and lower recurrence rate.In clinical practice,the appropriate operation should be selected according to the specific conditions of patients.