Perforated gastric ulcer causing mediastinal emphysema: A case report

BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,esophageal perforation,medi-cally induced factors,etc.Its common symptoms are chest pain,tightness in the chest,and respiratory distress.Most mediastinal emphysema patients have mild symptoms,but severe mediastinal emphysema can cause respiratory and circulatory failure,resulting in serious consequences.CASE SUMMARY A 75-year-old man,living alone,presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol.Due to the remoteness of his residence and lack of neighbors,the patient was found by his nephew and brought to the hospital the next morning after the disease onset.Computed tomography(CT)showed free gas in the abdominal cavity,mediastinal emph-ysema,and subcutaneous pneumothorax.Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated.Therefore,we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia.An operative incision of the muscle layer of the patient's abdominal wall was made,and a large amount of subperitoneal gas was revealed.And a continued incision of the peritoneum revealed the presence of a perforation of approx-imately 0.5 cm in the gastric antrum,which we repaired after pathological examination.Postoperatively,the patient received high-flow oxygen and cough exercises.Chest CT was performed on the first and sixth postoperative days,and the mediastinal and subcutaneous gas was gradually reduced.CONCLUSION After gastric perforation,a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm,and upper gastrointestinal angiography can clarify the site of perforation.In patients with mediastinal emphysema,open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure.In addition,thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.

Treatment of perforated giant gastric ulcer in an emergency setting

AIM:To study and assess clinical outcomes of various modes of treatment for perforated giant gastric ulcer in an emergency setting.METHODS:From May 2010 to February 2013,20cases of perforated giant gastric ulcer(>2 cm)were operated on in an emergency setting.All the patients presented with features of peritonitis and were resuscitated aggressively before taking for surgery.In the first4 cases,primary closure was done after taking a biopsy and among these,the 3rdcase also underwent partial distal gastrectomy and gastrojejunostomy and the 4th case underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy for malignancy.All the remaining 16 cases underwent partial distal gastrectomy and gastrojejunostomy.RESULTS:Among the first 4 cases,2 had an uneventful recovery and were discharged on the 6thpostoperative day.The 3rdand 4thpatients developed gastricfistula,leading to prolonged hospitalization.For the 3rd patient,conservative management was tried for 1 wk,followed by partial distal gastrectomy and gastrojejunostomy,and he was discharged on the 20thday after admission,while the 4thpatient underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy.Postoperatively,he developed adult respiratory distress syndrome,multiorgan dysfunction syndrome and expired on the 3rdpostoperative day of the second surgery.All the remaining 16 patients underwent partial distal gastrectomy and gastrojejunostomy and recovered well.Among these,4 of them were malignant and the remaining were benign ulcers.All had an uneventful recovery.The percentage of malignancy in our series was 30%(6 out of 20 cases).In our study,86%had an uneventful recovery,complications were seen in about 10%,and mortality was about 5%.CONCLUSION:In giant gastric ulcer,the chances of malignancy and leak after primary closure are high.So,we feel that partial distal gastrectomy and gastrojejunostomy is better.

Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively.We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure.In December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection.Intensive conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.

Gastric Cancer Revealed by a Perforated Ulcer: A Case Report and Review

Introduction: Gastric cancer is not typically a surgical emergency. However, it can evolve into urgent complications such as a perforation. We report a case of a perforated gastric ulcer that turned out to be a cancer. Observation: A 52-year-old man was admitted to the emergency department of Hubert-Koutoukou-Maga National University Medical Center in Cotonou for generalized abdominal pain. He was diagnosed with acute generalized peritonitis with perforated gastric ulcer, establishing a surgical indication. An antral perforation was found and a simple closure was performed. Anatomopathological examination of the surgical piece revealed a gastric adenocarcinoma within the granulation tissue. Following the impact assessment, he underwent a second surgery where a distal gastrectomy was performed with D2 lymphadenectomy followed by gastrojejunostomy. He developed an anastomotic gastrointestinal fistula during the postoperative period but was successfully medically treated. The patient received adjuvant chemotherapy with Epirubicin, Cisplatin and 5-Fluorouracil. The patient is still alive, 3 years after the gastrectomy. Conclusion: When faced with a perforated gastric ulcer, one must also consider a neoplastic cause. The emergency surgical treatment depends on the general condition of the patient and the pre-existing co-morbidities, the choice being made between a one-stage versus two-stage gastrectomy.

Epidemiology of perforating peptic ulcer:A population-based retrospective study over 40 years

BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades,but the incidence of reported peptic ulcer complications has not decreased.Perforating peptic ulcer(PPU)is a severe form of the disease.AIM To assess trends in the incidence,presentation,and outcome of PPU over a period of 40 years.METHODS This was a single-centre,retrospective,cohort study of all patients admitted to Levanger Hospital,Norway,with PPU from 1978 to 2017.The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases(ICD),revision 8,ICD-9,and ICD-10 codes for perforated gastric and duodenal ulcers.We reviewed the medical records of the patients to retrieve data.Vital statistics were available for all patients.The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable,and sex,age,and calendar year from 1978 to 2017 as covariates.Relative survival analysis was performed to compare long-term survival over the four decades.RESULTS Two hundred and nine patients were evaluated,including 113(54%)men.Fortysix(22%)patients were older than 80 years.Median age increased from the first to the last decade(from 63 to 72 years).The incidence rate increased with increasing age,but we measured a decline in recent decades for both sexes.A significant increase in the use of acetylsalicylic acid,from 5%(2/38)to 18%(8/45),was observed during the study period.Comorbidity increased significantly over the 40 years of the study,with 22%(10/45)of the patients having an American Society of Anaesthesiologists(ASA)score 4-5 in the last decade,compared to 5%(2/38)in the first decade.Thirty-nine percent(81/209)of the patients had one or more postoperative complications.Both 100-day mortality and long-term survival were associated with ASA score,without significant variations between the decades.CONCLUSION Declining incidence rates occurred in recent years,but the patients were older and had more comorbidity.The ASA score was associated with both short-term mortality and long-term survival.

Perforated gastrointestinal ulcers presenting as acute respiratory distress

BACKGROUND:Dyspnea is one of the most common complaints facing the emergency medicine physician.Some of the gastrointestinal causes of dyspnea are self-limited and not lifethreatening,yet others are,and early diagnosis and treatment are crucial.METHODS:In this article we presented one of these life-threatening conditions through a clinical description of a patient presenting with acute respiratory distress that was finally diagnosed to be the result of a perforated gastric ulcer.RESULTS:An emergent thoracotomy revealed a small ulcer with perforation in the fundus of the stomach.The patient was transferred after the operation to the intensive care unit and after a prolonged hospitalization discharged home.Biopsies taken from the ulcer showed diffuse inflammation,with no evidence of microorganisms or malignancy.CONCLUSION:Perforation of gastric and duodenal ulcers is a rare yet existing cause of dyspnea and respiratory failure and should be kept in mind by the emergency physician,especially when other more common causes are ruled out.

Posterior Gastric Perforation in Liberia: A Case Report and Review of the Literature

Background: The incidence of posterior gastric perforation worldwide is low;the literature has no previous record of its occurrence in Liberia. The diffuse symptoms of a perforated posterior gastric ulcer, delay by patients before they present to hospital, and the lack of skilled personnel and facilities in Liberia to diagnose and treat this condition increase the mortality associated with posterior gastric perforation. Objective: To report the first case of posterior gastric perforation encountered in Liberia. Materials and Method: Case report. Case Presentation/Report: A 44 year old male was referred to John F. Kennedy Memorial Hospital (Liberia’s principal teaching hospital) with a diagnosis of gastritis after six days of worsening epigastric pain. He had a history of NSAID use for a chronic leg and foot ulcer. Physical examination revealed a moderately distended, markedly tender abdomen characterized by guarding, rigidity and low-pitched bowel sounds. Patient was resuscitated with intravenous fluids, antibiotics and analgesics. An emergency exploratory laparotomy subsequently performed revealed a large collection of purulent peritoneal fluid, a 3 × 4 cm perforation on the posterior wall of the stomach and a 3 × 2.5 cm perforation of the transverse mesocolon. The perforations were repaired and the patient recovered satisfactorily. Conclusion: Though relatively rare and associated with a high morbidity and mortality, this case report shows that the paucity of reported cases of posterior gastric perforation may also be attributable to lack of specialist staff with capacity for clinical diagnosis and surgical intervention in a resource poor setting. Identifying patients with gastric perforation and having the skill to repair the perforations significantly enhance the clinical outcome.

Perforations of Gastro-Duodenal Ulcers in the Surgery Department “A” at the University Hospital Point G Bamako

The purpose of this study was to investigate the clinical and therapeutic aspects of peritonitis by perforation of gastric and duodenal ulcer. This was a retrospective and descriptive study over 8 years (2010-2018) which allowed to collect 54 cases of peptic ulcer. Included in the study were all patients with confirmed gastroduodenal perforation on histology or laparotomy. We collected 54 cases of peptic ulcer perforated s. The age group of 30 - 49 years was the majority. The male sex was dominant with 90.7% of cases;the clinical picture was dominated by abdominal contracture associated with pain in 74.07% of cases. X-ray of the abdomen without preparation (AWP) revealed in 87.03% of cases of pneumoperitoneum. The perforation was in 68.52% of cases on the gastric antrum and in 31.48% on the duodenum. The surgical procedure used was the bank of excision, and a suture reinforcement epiploic in 68.52% of cases, a simple suture made in 31.48% of cases, the disease was marked by a fistula (1.90%) and mortality was 5.55% of cases. The gastroduodenal ulcer perforation is potentially serious and responsible peritonitis whose surgical treatment involves the peritoneal toilet and sutures the puncture.

Gastric conduit perforation

As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized.

A CLINICAL STUDY ON THE SUBTOTAL GASTRECTOMY UNDER ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA OF SMALL DOSAGE

We have performed operations on the patients with perforation of gastric ulcer forsubtotal gastrectomy under acupuncture combined with epidural anesthesia of smaIl dosage （studygroup） or epidural anesthesia only（control gr0up） at rand0m, 2O cases in each group. There is no ob-vious difference of successful rates between tw0 groups （P】O. O5）. But the fluctuation of the bloodpressure of the study group is smaller than that of the control group（PwtO- O1 ）; the comparison of thefluctuations of capacity of vessel and the changes 0f TMwave of ECG before and during operationshows that the study group is better than control gr0up （PrO. O1, P【O. O5, respectively）; in thestudy group, WBC is decreased significantly after operation, while in the control guoup, CRP（C-re-active pr0tein） is markedIy increased, there are significant differences of these indices between twogroups（P【0. 05, respectively）; complement C3, IgA, IgG and IgM are decreased to a different ex- tent after operation in both groups, but the

腹腔镜胃穿孔修补术联合质子泵抑制剂对胃溃疡穿孔患者血清胃泌素、胃电参数及炎性状态的影响

目的分析腹腔镜胃穿孔修补术联合质子泵抑制剂(PPI)对胃溃疡穿孔患者胃泌素、胃电参数及炎性状态的影响。方法选取2017年4月—2022年4月永州市第三人民医院收治的140例胃溃疡穿孔患者,按照治疗方法的差异分为研究组和对照组,各70例。两组患者均行腹腔镜胃肠穿孔修补术,术后研究组患者增用PPI,对比两组患者术后指标以及手术前后胃泌素、胃电参数、胃黏膜屏障功能和炎性状态。结果研究组术后肠鸣音恢复时间、肛门排气时间和拔管时间均早于对照组(P<0.05)。手术后,两组胃动素水平较手术前升高,且研究组高于对照组(P<0.05),两组胃泌素水平较手术前降低,且研究组低于对照组(P<0.05)。手术后,两组胃电幅值、正常慢波节律比、胃电频率和胃电主功率均较手术前升高,且研究组高于对照组(P<0.05)。手术后,两组VEGF、TGF-β水平较手术前升高,且研究组高于对照组(P<0.05),两组黏膜厚度评分、腺体密度评分较手术前降低,且研究组低于对照组(P<0.05)。手术后,两组CRP、TNF-α水平较手术前降低,且研究组低于对照组(P<0.05),两组IL-8水平较手术前升高,且研究组高于对照组(P<0.05)。结论腹腔镜胃穿孔修补术联合PPI在胃溃疡穿孔中的效果显著,不仅利于患者术后胃肠功能恢复,还可减轻胃窦部损伤,改善胃黏膜屏障功能,减轻炎症反应。

猫胃肠道嗜酸性硬化性纤维增生症导致胃溃疡穿孔的病例分析

为丰富猫胃肠道嗜酸性硬化性纤维增生症(FGESF)在我国宠物临床上的诊断治疗数据,本文报道了1例5岁家养短毛猫因FGESF导致胃溃疡穿孔后通过手术治疗并恢复的病例,同时结合国内外病例报告,讨论FGESF的可能病因、临床症状、诊断、治疗和预后,为国内临床类似病例的诊断和治疗提供参考。

腹腔镜下穿孔修补术治疗中老年十二指肠溃疡合并胃穿孔的疗效及对胃肠动力的影响分析

目的分析中老年十二指肠溃疡合并胃穿孔采取腹腔镜下穿孔修补术治疗的临床效果及对胃肠动力的影响。方法78例中老年十二指肠溃疡合并胃穿孔患者作为观察对象,按照随机数字表法分为观察组(腹腔镜下穿孔修补术,39例)和对照组(常规手术,39例)。对比两组临床疗效、术中出血量、术后肛门排气时间、肠鸣音恢复时间、住院时间、并发症(切口感染、肠梗阻、腔隙感染)发生率及治疗前后Barthel指数、视觉模拟评分法(VAS)评分。结果观察组总有效率89.7%高于对照组的71.8%,差异明显(P<0.05)。治疗后,两组VAS评分低于治疗前,Barthel指数高于治疗前,且观察组VAS评分(1.69±0.15)分低于对照组的(3.45±0.12)分,Barthel指数(91.45±3.23)分高于对照组的(81.23±6.15)分(P<0.05)。观察组术后肛门排气时间(27.72±5.23)h、肠鸣音恢复时间(12.41±4.23)h、住院时间(5.23±0.23)d短于对照组的(42.39±3.53)h、(27.51±3.34)h、(10.88±1.22)d,术中出血量(42.62±3.23)ml少于对照组的(73.24±5.31)ml,差异明显(P<0.05)。观察组并发症发生率10.3%低于对照组的30.8%,差异明显(P<0.05)。结论中老年十二指肠溃疡合并胃穿孔采取腹腔镜下穿孔修补术治疗可明显提高治疗效果,较常规手术更能减轻术后疼痛感,同时还可促进胃肠功能恢复,降低手术后并发症发生率,值得推广。

艾司奥美拉唑在腹腔镜胃溃疡穿孔倒刺线缝合修补术后辅助治疗中的应用价值

目的探讨艾司奥美拉唑在腹腔镜胃溃疡穿孔倒刺线缝合修补术后辅助治疗中的应用价值。方法选取2021年9月至2023年9月抚州市第一人民医院急诊外科收治的68例胃溃疡穿孔患者作为研究对象,随机分为对照组与观察组,各34例。两组均实施腹腔镜胃溃疡穿孔修补术治疗,对照组术后予以其他药物治疗,观察组术后则联合艾司奥美拉唑治疗。比较两组临床疗效、血清转化生长因子α(TGF-α)水平、胃泌素(Gas)水平、血清炎症因子指标[C-反应蛋白(CRP)、白细胞介素-6(IL-6)]、免疫功能指标(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))。结果观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05);治疗后,两组TGF-α水平均高于治疗前,Gas水平均低于治疗前,且观察组TGF-α水平高于对照组,Gas水平低于对照组,差异有统计学意义(P<0.05);治疗后,两组CRP、IL-6水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后,两组CD4^(+)水平及CD4^(+)/CD8^(+)均高于治疗前,CD8^(+)水平低于治疗前,且观察组CD4^(+)水平及CD4^(+)/CD8^(+)均高于对照组,CD8^(+)水平低于对照组,差异有统计学意义(P<0.05)。结论艾司奥美拉唑在腹腔镜胃溃疡穿孔倒刺线缝合修补术后辅助治疗的应用价值较高,不仅可改善患者黏膜环境,促进溃疡恢复,还能避免机体炎症反应加剧,调节机体免疫功能,进一步巩固手术疗效,促进病情康复。

腹腔镜下穿孔修补术治疗胃及十二指肠溃疡急性穿孔的效果分析

探究腹腔镜下穿孔修补术治疗胃及十二指肠溃疡急性穿孔的效果。选取2022年1月—2022年12月遵义医科大学第三附属医院收治的94例胃及十二指肠溃疡急性穿孔患者为研究对象,采用随机数字表法将其分为对照组(n=47,行传统开腹术)、观察组(n=47,行腹腔镜下穿孔修补术),对比两组患者疗效。结果显示,观察组患者围术期指标及术后胃肠功能指标均优于对照组(P<0.05);术前两组患者疼痛评分差异无统计学意义(P>0.05),术后疼痛评分均有下降,且观察组分值低于对照组(P<0.05);观察组患者并发症总发生率低于对照组(P<0.05);术后,观察组患者除物质生活功能以外其他各项生活质量评分均高于对照组(P<0.05)。研究发现,腹腔镜下穿孔修补术对胃及十二指肠溃疡急性穿孔患者治疗效果确切,可减轻创伤,利于患者术后恢复,于胃肠功能恢复有益。

腹腔镜与开腹手术治疗老年胃溃疡并穿孔的治疗效果研究

目的探讨老年胃溃疡并穿孔在临床中采用开腹穿孔修补术和腹腔镜穿孔修补术两种方式治疗的临床效果。方法方便选取2017年6月—2021年5月潜江市中心医院收治的胃溃疡并胃穿孔的84例患者为研究对象,按照患者所采用的不同治疗方式分为参照组30例(采取开腹穿孔修补术)、研究组54例(采取腹腔镜穿孔修补术)。对比两组患者手术指标、VAS评分、术后血清胃泌素含量、并发症发生率。结果研究组患者采用腹腔镜穿孔修补术治疗后患者的各项手术指标、不同时间的VAS评分、术后1、24、48、72 h血清胃泌素的含量优于参照组,差异有统计学意义(P<0.05)。研究组治疗后并发症的总发生率占3.3%,显著低于参照组的20.0%,差异有统计学意义(χ^(2)=6.109,P<0.05)。结论老年胃溃疡患者应用腹腔镜穿孔修补术后能够显著降低患者的疼痛以及术后并发症发生情况,可显著提升患者术后预期和生活质量,临床效果显著。

腹腔镜下修补术联合奥美拉唑三联治疗胃、十二指肠溃疡穿孔的效果观察

目的探讨腹腔镜下修补术联合奥美拉唑三联治疗胃、十二指肠溃疡穿孔的效果。方法86例胃、十二指肠溃疡穿孔患者随机分为两组,对照组实施腹腔镜下修补术治疗,观察组实施腹腔镜下修补术联合奥美拉唑三联治疗,比较两组的临床疗效、临床指标、术后并发症及穿孔复发率。结果治疗后,观察组的总有效率高于对照组,拔管时间、住院时间均短于对照组,术后并发症发生率低于对照组(P<0.05)。两组术后3个月内的穿孔复发率比较,差异无统计学意义(P>0.05)。结论腹腔镜下修补术联合奥美拉唑三联治疗胃、十二指肠溃疡穿孔的效果确切,可降低术后并发症发生风险。

腹腔镜胃穿孔修补术对胃溃疡合并胃穿孔患者胃肠功能及炎症因子水平的影响

目的探讨腹腔镜胃穿孔修补术治疗对胃溃疡合并胃穿孔患者胃肠功能及炎症因子水平的影响。方法随机抽取2020年1月—2022年1月期间福建医科大学附属泉州第一医院收治的胃穿孔合并胃溃疡患者180例开展研究,随机划分A、B两组,各90例,A组采用开腹胃穿孔修补术,B组采用腹腔镜胃穿孔修补术。对比两组术后并发症发生率、胃肠功能指标、炎症因子水平、临床指标。结果B组术后并发症总发生率为1.11%低于A组的11.11%,差异有统计学意义(χ^(2)=7.842,P<0.05)。B组术后MTL、GAS、GIP高于A组,差异有统计学意义(t=11.265、4.016、5.637,P<0.001)。B组术后IL-6、TNF-α、CRP低于A组,差异有统计学意义(t=11.641、28.813、7.352,P<0.001)。B组术后1、3、7 dVAS评分及术中出血量低于A组,差异有统计学意义(t=12.327、22.071、34.652、24.641,P<0.001)。B组切口长度、肛门首次排气时间、住院时间短于A组,差异有统计学意义(t=52.342、10.121、8.725,P<0.001)。结论腹腔镜胃穿孔修补术在胃溃疡合并胃穿孔患者治疗中的应用效果理想。

新型一次性软组织闭合夹系统治疗猪胃穿孔的疗效和安全性

目的在猪胃穿孔模型使用不同型号的新型一次性软组织闭合夹系统,行内镜下闭合,评价其有效性和安全性。方法采用小型猪建立10 mm的胃壁穿孔模型,对照组和实验组各6只。对照组于胃窦部建立1处穿孔模型,置入对照品闭合夹4枚;实验组于胃窦部建立2处胃穿孔模型,分别置入供试品A、B型闭合夹各1枚。记录动物术后的一般情况,术后第8、15天胃镜下观察穿孔闭合及修复情况,第36天取大体标本行病理学观察组织愈合和炎症情况。结果对照组和实验组闭合夹置入成功率均为100%,动物均存活,创面愈合良好。对照组闭合夹脱落率为83.3%(5/6),实验组A型闭合夹无脱落,B型闭合夹脱落率为16.7%(1/6)(P<0.05)。实验组创面愈合趋势更优。2组均未发生不良并发症。结论在本实验条件下,内镜下使用一次性软组织闭合夹系统可有效闭合胃穿孔,操作简易,具备良好的有效性和安全性。

采用腹腔镜下穿孔修补术治疗胃溃疡合并胃穿孔的疗效评价

目的针对胃溃疡合并胃穿孔患者实施腹腔镜下穿孔修补术治疗的临床疗效展开分析与探讨。方法选取2021年1月—2022年4月安溪县医院收治的胃溃疡合并胃穿孔患者74例作为研究对象,根据单双号分为对照组、观察组,每组37例。对照组采取开腹穿孔修补术治疗,观察组采取腹腔镜下穿孔修补术治疗。比较两组临床疗效、手术指标、临床指标、并发症。结果观察组总有效率为97.30%,高于对照组的78.38%,差异有统计学意义(χ^(2)=4.553,P<0.05)。观察组手术时间、术中出血量、切口长度、胃肠功能恢复时间、肛门排气时间、引流管拔除时间、住院时间均低于对照组,差异有统计学意义(P<0.05)。观察组术后1、3 d血清胃泌素均高于对照组,且疼痛评分均低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为5.41%,低于对照组的21.62%,差异有统计学意义(χ^(2)=4.162,P<0.05)。结论采用腹腔镜下穿孔修补术对胃溃疡合并胃穿孔患者实施治疗,具有较高临床疗效,有助于改善各种手术指标和临床指标,该方法的并发症发生率低,安全性良好,适合推广。