急性上消化道穿孔非手术治疗效果与治疗指征的探讨  

Effects and indications of non-operative management for acute upper gastrointestinal perforation

作　　者：梁堂帅[1] 孙楠 张宝磊 赵丙波[1] 杨道贵[1] Liang Tangshuai;Sun Nan;Zhang Baolei;Zhao Bingbo;Yang Daogui(Department of Gastrointestinal Surgery,Liaocheng People's Hospital,Shandong Province 252000,China)

机构地区：[1]聊城市人民医院胃肠外科,山东省252000

出　　处：《中华普通外科杂志》2020年第9期716-720,共5页Chinese Journal of General Surgery

摘　　要：目的评估非手术治疗急性上消化道穿孔的疗效并探讨其治疗指征.方法回顾性分析2016年1月至2018年12月聊城市人民医院胃肠外科出院诊断为急性上消化道穿孔并将非手术治疗作为首要治疗方式的192例患者的临床资料,分为非手术治疗组(保守组163例)和中转手术组(手术组29例),通过单因素和多因素分析影响治疗效果的危险因素.结果192例急性上消化道穿孔患者均治愈出院,无严重并发症及死亡患者,非手术治疗有效率为84.9%.穿孔时间(OR=0.238,P=0.046)、心率(OR=1.043,P=0.004)、血清白蛋白(OR=0.869,P=0.002)是影响疗效的独立危险因素.结论非手术治疗急性上消化道穿孔是安全有效的,穿孔时间、心率、血清白蛋白是影响其疗效的独立影响因素.发病时间>12h、心率>100次/min、血清白蛋白低于正常、血清降钙素原质量浓度明显高于正常时,要谨慎选择非手术治疗.Objective To evaluate the curative effect of non-surgical treatment of acute upper gastrointestinal perforation and analyze the risk factors.Methods We retrospectively reviewed medical records of patients who were diagnosed with acute upper gastrointestinal perforation from Jan 2016 to Dec-2018 in Liaocheng Peoples Hospital.At first,all patients were put on non-surgical treatment.According to whether or not converted to surgery,they were divided into non-surgical treatment group(163 cases)and surgery group(29 cases).Univariate analyses and multivariate analyses were conducted.Results 192 patients with acute upper gastrointestinal perforation were cured without serious complications and death.The non-surgical treatment efficiency was 84.9%.The onset time(OR=0.238,P=0.046),heart rate(OR=1.043,P=0.004),serum albumin(OR=0.869,P=0.002)are independent risk factors.Conclusion Non-surgical treatment of acute upper gastrointestinal perforation is safe and effective.Onset time,heart rate and serum albumin are independent risk factors.In patients when time of onse t>12h,heart rate>100 beats/min,hypoalbuminemia,and high level of procalcitonin,conversion to surgery should be considered.

关 键 词：消化性溃疡穿孔 治疗结果 非手术治疗 

分 类 号：R656.1[医药卫生—急诊医学]