老年胃十二指肠溃疡急性穿孔的外科治疗:附89例报告

Surgical treatment of acute perforated gastroduodenal ulcer in old patients: a report of 89 cases

目的 探讨老年胃十二指肠溃疡急性穿孔的外科治疗。方法 回顾分析近 10年 89例老年胃十二指肠溃疡急性穿孔的治疗效果 ,对年龄、合并症、发病至手术时间、手术方式、全身炎症反应综合征 (SIRS)和多器官功能障碍综合征 (MODS)等影响预后的因素进行分析。结果 78例行单纯修补 ,11例行胃大部分切除 ;死亡 12例。 70岁以下年龄组术后并发症发生率及死亡率低于 70岁以上年龄组 (P <0 .0 5 ) ;发病至手术时间 12h以内组并发症发生率、死亡率低于 12h以上组 (P <0 .0 5 ,P <0 .0 1) ;合并单种并存病组的并发症发生率、死亡率低于两种或以上组 ( P <0 .0 5 ,P <0 .0 1) ;MODS两器官受累组的死亡率低于两器官以上组 (P <0 .0 5 )。手术方式的选择与并发症发生率、死亡率和治疗效果无明显差异 ( P >0 .0 5 )。结论 对老年胃十二指肠溃疡急性穿孔的手术应以单纯修补为主。

Objective To evaluate the surgical treatment of old patients with acute perforated gastroduodenal ulcer. Method The age, complications, duration of the disease history, operative method, systemic inflammatory response syndrome (SISR) and multiple organ dysfunction syndrome (MODS) in 89 old patients with acute perforated gastroduodenal ulcers were analyzed retrospectively. Results Simple closure operation was performed in 78 cases and subtotal gastrectomy in the other 11 cases. Twelve patients died. The mortality and complications rate were significantly lower in the patients less than 70 -year old than those in the patients more than 70-year old (P<0.05), and also lower in disease history less than 12 hours than those in over 12 huors (P<0.05, P<0.01). The mortality and complications rate in patients with single accompaning disease or with MODS involving only 2 organs was lower than that in patients with multiple accompaning disease (P<0.05, <0.01) or with MODS involving 3 organs or more ( P<0.05) . The operative methods did not correlate with the complications, mortality or MODS. Conclusions The simple closure operation should be the mainly selection for the acute perforated gastroduodenal ulcer in the old patients.