不同手术方法治疗胃十二指肠溃疡穿孔的疗效比较研究  

The efficacy of different surgical methods in treatment of gastric ulcer perforation

作　　者：王建锋 刘卫怀 

机构地区：[1]宁波市宁海县城关医院四病区普外科,浙江宁海315600 [2]宁波市北仑区人民医院普外科,浙江宁波315800

出　　处：《中国现代医生》2013年第28期37-39,共3页China Modern Doctor

基　　金：浙江省宁波市医学科技计划项目(2007025)

摘　　要：目的比较分析不同手术方法治疗胃十二指肠溃疡穿孔的疗效,为消化性溃疡穿孔的治疗方法的选择提供指导依据。方法选择2009年1月～2013年1月来我院进行手术治疗的胃十二指肠溃疡穿孔患者60例作为观察对象,其中30例行单纯缝合修补术,设立为A组,其余行胃大部切除术或高选择性迷走神经切除术+修补术共30例设立为B组,比较两组患者的手术时间、术中出血量、术后住院时间及并发症发生率、术后随访不同时间其复发率情况。结果 A组的手术时间、术中出血量、住院时间均明显短于B组,组间进行t检验显示,差异有统计学意义(P<0.05)。A组并发症发生率明显少于B组,差异具有统计学意义(P<0.05)。术后随访3年,其中A组复发率达40%,B组术后复发率达10%,两组复发率比较,差异具有统计学意义,B组复发率明显低于A组(P<0.05)。结论单纯缝合修补术治疗胃十二指肠溃疡急性穿孔手术时间短、术后并发症少,胃大部切除术术后远期随访溃疡复发率低,两种手术方法各具优缺点,因此,对胃及十二指肠溃疡穿孔患者应根据其实际状况选择手术方式。Objective To compare the efficacy of different surgical methods in treatment of gastric ulcer perforation, and to provide guidance based for the choice of methods. Methods From January 2009 January 2013 in our hospital, 60 patients with gastric ulcer perforation as an object of observation,of which 30 cases simple suture repair, set up for the group A,the rest of gastric gastrectomy or highly selective vagotomy surgery and repair 30 cases as the group B, the operative time,blood loss,postoperative hospital stay and the incidence of complications, postoperative follow-up time of the recurrence rates of different situations were compared between two groups. Results Group A of operative time,blood loss,hospital stay was significantly shorter than group B,the difference was statistically significant（P〈0.05）.Complication rate in group A was significantly less than in group B, the difference was statistically significant（P〈0.05）. Postoperative follow-up 3 years, the recurrence rate in group A was 40%,group B of recurrence rate was 10%,respectively,the differ- ence was statistically significant, the recurrence rate of group B was significantly lower than group A（P〈0.05）.Con- clusion A simple suture treatment of acute perforated gastric ulcer have shorter operative time, less postoperative complications after gastrectomy term follow-up ulcer recurrence rate, each methods with advantages and disadvantages, so the stomach and duodenal ulcer patients should be selected according to the actual situation of surgical approach.

关 键 词：胃十二指肠溃疡穿孔 单纯缝合修补术 胃大部切除术 复发率 

分 类 号：R656.62[医药卫生—外科学]