巨大消化性溃疡穿孔治疗中改良式四步法修补术的应用分析  

Application analysis on modified four-step repair technique in the treatment of perforated giant peptic ulcer

作　　者：林勇[1] 林贤平[1] LIN Yong;LIN Xianping(Department of General Surgery,Fuzhou Second Hospital,Fuzhou 350007,China)

机构地区：[1]福州市第二医院普外科,福建福州350007

出　　处：《中国现代医生》2020年第33期73-76,共4页China Modern Doctor

摘　　要：目的探讨及总结巨大消化性溃疡穿孔修补手术处置策略及围手术期疗效。方法回顾性选取2014年1月~2020年5月本院采用改良式四步法修补术治疗的巨大消化性良性溃疡穿孔患者20例作为观察组,选取同期实施小穿孔常规修补术治疗直径<1.0 cm的良性消化性溃疡穿孔患者20例作为对照组。比较两组围术期相关指标、并发症发生情况及临床症状评分。结果两组并发症发生率比较,差异无统计学意义(P>0.05),观察组患者术后无一例发生瘘及腹腔脓肿,均进半流质饮食后顺利出院。对照组禁食时间、胃肠减压时间、住院时间、治疗费用少于观察组,差异有统计学意义(P<0.05)。治疗后两组患者反酸、嗳气、上腹部疼痛程度评分均明显下降,且治疗后两组患者各项症状评分比较,差异无统计学意义(P>0.05)。结论采用改良式四步法修补术治疗巨大消化性溃疡穿孔,临床效果满意,较直径在1.0 cm以下的良性消化性溃疡穿孔患者仅增加禁食时间、胃肠减压时间、住院时间及治疗费用,未增加并发症发生率。Objective To discuss and summarize the strategy and perioperative curative effect of repair surgery of perforated giant peptic ulcer.Methods A total of 20 cases of perforated giant peptic benign ulcers who were admitted and treated with a modified four-step repair technique in our hospital from January 2014 to May 2020 were reviewed and selected as the observation group.A total of 20 patients with perforated benign peptic ulcer with the diameter less than 1.0 cm undergoing surgery during the same period were selected as the control group.Routine repair of small perforations was performed.The perioperative indicators,complications and clinical symptom scores were compared between the two groups.Results There was no significant difference in the incidence rate of complications between the two groups(P>0.05).The patients in the observation group showed no fistula or abdominal abscess after the surgery,and they were discharged after receiving a semi-liquid diet.The fasting time,gastrointestinal decompression time,length of stay,and treatment cost in the control group were less than those in the observation group,the differences weresignificantly(P<0.05).After treatment,the scores of acid regurgitation,belching,and upper abdominal pain were significantly decreased in both groups.After treatment,there was no significant difference in the scores of each symptom between the two groups(P>0.05).Conclusion The above-mentioned four-step repair method combined with trimming of the omentum pedicle is effective and satisfactory in repairing perforated benign giant peptic ulcer.Compared with patients with general perforated ulcers,those patients only have longer fasting time,longer length of hospital stay,and relatively increased costs of hospitalization.This method does not increase the perioperative patients'surgery-related complications.

关 键 词：消化性溃疡穿孔 巨大穿孔 修补术 带蒂大网膜片 围术期 

分 类 号：R615[医药卫生—外科学]