胃十二指肠溃疡急性穿孔应用单纯穿孔修补术的 临床分析

向东+周檎

[摘要] 目的 探讨单纯穿孔修补术在胃十二指肠溃疡急性穿孔单纯穿孔修补术的临床应用效果。 方法 方便选取该院2016年9月—2017年1月治疗的100例十二指肠溃疡急性穿孔患者，随机分组，分成对照与实验组，每组50例。对照组采用常规胃大部切除术，实验组采用单纯穿孔修补术来治疗胃十二指肠溃疡急性穿孔。对比两组患者的手术时间、住院时间、术后排气时间、复发率、并发症率。 结果 实验组在手术时间（40.02±12.21）min、住院时间（24.12±5.02）h、术后排气时间（7.18±1.25）d明显小于对照组，差异有统计学意义（P<0.05）。实驗组复发率（4.0%）、并发症率（4.0%）均明显低于对照组，差异有统计学意义（P<0.05）。 结论 单纯穿孔修补术在胃十二指肠溃疡急性穿孔治疗上效果显著，值得医院推广。

[关键词] 胃十二指肠溃疡；急性穿孔；穿孔修补术；临床效果

[中图分类号] R656 [文献标识码] A [文章编号] 1674-0742（2017）05（c）-0105-03

[Abstract] Objective To discuss the application effect of repair of peptic ulcer perforation in the acute perforation of gastroduodenal ulcer. Methods 100 cases of patients with acute perforation of gastroduodenal ulcer treated in our hospital from September 2016 to January 2017 were conveniently selected and randomly divided into two groups with 50 cases in each， the control group and the experimental group respectively adopted the routine subtotal gastrectomy and simple repair of peptic ulcer perforation， and the operation time， length of stay， postoperative exhaust time， recurrence rate and complication rate were compared between the two groups. Results The operation time， length of stay and postoperative exhaust time in the experimental group were respectively （40.02±12.21）min， （24.12±5.02）h and （7.18±1.25）d， which were obviously less than those in the control group， and the differences were statistically significant（P<0.05）， and the recurrence rate and complication rate in the experimental group were respectively 4.0% and 4.0%， which were obviously lower than those in the control group， and the differences were statistically significant（P<0.05）. Conclusion The effect of simple repair of peptic ulcer perforation in the acute perforation of gastroduodenal ulcer is obvious， which is worth promotion in the hospital.

[Key words] Gastroduodenal ulcer； Acute perforation； Repair of peptic ulcer perforation； Clinical effect

胃十二指肠溃疡患者的幽门螺杆菌（H p）、非甾体消炎药以及情绪的激动、不合理的休息时间等因素都可能是胃十二指肠溃疡急性穿孔的主要原因[1]。2013年的日本医学前瞻性研究结果显示，在以前推荐的小剂量的非甾体消炎药也可导致患者的消化道黏膜损害，同样Hp感染也与胃十二指肠溃疡穿孔关系密切。胃在药物方面，尽管新型制酸药物的使用， 提高了溃疡病的治愈率，减少溃疡病择期手术， 但其并发急性穿孔的发病率并无相应改变， 并且发病年龄渐趋高龄化[2]。手术治疗方面， 胃大部分切除、高选择性迷走神经切断加穿孔修补术的病例逐渐减少，大部位切除术中选择迷走神经切断已经不再是治疗胃十二指肠溃疡患的最优选择，而单纯穿孔修补术是大多数病例的首选治疗方式[3]。……