消化性溃疡急性穿孔手术中胃肠吻合器的应用价值探讨  

Clinical application of gastrointestinal anastomat in surgical treatment of acute perforation of peptic ulcer

作　　者：陈宁波[1] 陈仿[1] 曾杰[1] 先迪[1] 张建成[1] 李伟[1] 胡卫建[1] 

机构地区：[1]四川省医学科学院四川省人民医院急诊外科,四川成都610072

出　　处：《实用医院临床杂志》2012年第1期67-69,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨胃肠吻合器在消化性溃疡急性穿孔行胃大部切除手术中的应用价值。方法 1995年1月至2010年12月我院急救中心外科收治的消化性溃疡急性穿孔行胃大部切除术患者739例,其中器械吻合组526例(BillrothⅠ术式治疗485例,BillrothⅡ式34例,Roux-en-y胃肠吻合7例),手工吻合组213例(BillrothⅠ术式治疗194例,BillrothⅡ式15例,Roux-en-y胃肠吻合4例)。结果器械吻合组与手工吻合组比较,手术时间[(105.0±18.2)分钟vs(154.0±35.1)分钟],术后胃肠功能恢复时间[(41.2±6.4)小时vs(65.6±12.4)小时]差异均有统计学意义(P<0.01);器械吻合组发生吻合口漏2例,无吻合口狭窄,吻合口出血5例;手工吻合组发生吻合口漏5例,吻合口狭窄2例,吻合口出血4例,器械吻合组并发症发生率明显低于手工吻合组(P<0.01)。结论术中应用胃肠吻合器能缩短手术时间和术后胃肠功能恢复时间,明显降低术后并发症的发生。Objective To discuss the superiority of the gastrointestinal anastomat in surgical treatment of acute perforation of gastroduodenal ulce （APPU） with subtotal gastrectomy. Methods 1067 cases of APPU were analyzed retrospectively in our emergency center from Jan 1995 to Dec 2010. 739 patients undergoing subtotal gastrectomy were divided into two groups, appliance group （anastomat anastomosis） with 526 cases and handiwork group （handiwork anastomosis） with 213 cases. In appliance group ,485 cases were operated by Billroth Ⅰ operation ,34 cases by Billroth Ⅱ operation and 2 cases by Roux-en-y stomach intestine anastomosis. In handiwork group, 194 cases were operated by Billroth I operation, 15 cases by Billroth Ⅱ operation and 4 cases by Roux-en-y stomach intestine anastomosis. Results Differences were significant in mean time of operation and mean functional recovery time of stomach intestine between the appliance group [ （105.0±18.2） rain, （41.2±6.4） h] and the handiwork group [ （ 154.0±35.1 ） min, （65.6±12.4） h] （P 〈 0.01 ）. Two cases of stoma] leak,no case of anastomotic stenosis and 5 cases of bleeding in stoma were found in appliance group. Five cases of stomal leak ,2 cases of anastomotic stenosis and 4 cases of bleeding in stoma were found in handiwork group. The complications in handiwork group were significantly lower than those in handiwork group （P 〈 0.01 ）. Conclusion The use of gastrointestinal anastomat can shorten operating time and functional recovery time of stomach intestine, which can reduce postoperative complications.

关 键 词：胃大部切除术 消化性溃疡 穿孔 胃肠吻合器 

分 类 号：R656.622[医药卫生—外科学] R656.61[医药卫生—临床医学]