胃十二指肠溃疡急性穿孔手术时机和手术方式探讨

Evaluation of the Opportunity and Methods of Operation for Acute Gastroduodenal Ulcer Perforation

目的 :探讨胃十二指肠溃疡急性穿孔手术治疗的时机和方式。方法 :按穿孔时间、年龄及腹腔积液量分组 ,评价手术时机 ;分析手术病人的住院时间、术后溃疡复发率及再手术率。结果 :穿孔时间 >8h ,年龄 >6 0岁 ,腹腔积液量 >2 0 0ml组与相应对照组手术率差异有显著意义。单纯缝合修补组住院时间显著低于胃大部切除术组 ,而溃疡复发率及再手术率二组无显著差异。结论 :穿孔时间、年龄及腹腔积液量对胃十二指肠溃疡急性穿孔手术时机的选择有重要意义 ;单纯缝合修补术应成为手术治疗的主要方式。

Objective: To evaluate the opportunity and methods of operation for gastroduodenal ulcer perforation.Methods:In accordance with time of perforation, age and quantity of peritoneal infusion, the operative opportunity was evaluated.The results of follow up were reviewed in 92 cases underwent operations.Results:The operative rate in the patients older than 60 years who had longer time than 8 h after perforation and more than 200 ml of peritoneal infusion amount was significant different from that of other patients.The simple perforation closure leaded a shorter time of hospitalization,compared with subtotal gastrectomy.However there was not any increase of recurrent rate of ulcer and reoperative in all the 92 patients who received operation.Conclusion:It is important to select operative opportunity according to the time of perforation,age and quantity of peritoneal infusion. Simple perforation closure should be a mainly operative method for acute gastroduodenal ulcer perforation.