消化性溃疡穿孔修补术的远期疗效  

Long term result of simple closure operation for perforated peptic ulcer

作　　者：倪志展 王松[1] 朱俩辰[1] 黄陈申 葛步军[1] 黄琦[1] Ni Zhizhan;Wang Song;Zhu Liacheng;Huang Chenshen;Ge Bunjun;Huang Qi(Department of General Surgery,Tongji Hospital of Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院普通外科,上海200065

出　　处：《中华普通外科杂志》2021年第1期47-49,共3页Chinese Journal of General Surgery

基　　金：同济医院临床研究培育项目[ITJ(ZD)1804]。

摘　　要：目的︰研究消化性溃疡穿孔修补术后患者远期再发穿孔等严重并发症的发生率及其危险因素,寻找预防再发严重并发症的方法。方法2010年1月至2014年6月在上海市同济医院普通外科接受穿孔修补术的117例上消化道溃疡穿孔患者,随访术后3个月内是否行内镜检查,根治幽门螺旋杆菌治疗,术后是否继续吸烟.饮酒,是否服用非甾体类消炎药,溃疡症状,是否出现穿孔出血,梗阻等严重并发症。结果﹑本组117例患者术后3个月内行胃镜检查22例(21.4%),接受幽门螺旋杆菌根治治疗5例。共有10例患者(12例次)发生严重溃疡并发症,其中幽门梗阻6例,再次穿孔4例,溃疡出血2例。从穿孔手术至首次发生严重并发症平均间隔(24.8±5)个月。2例穿孔及1例反复梗阻者行手术治疗,其余患者均行保守治疗。与严重并发症组比较,未发生严重并发症组患者术后早期行胃镜检查比例较高(23.7%比0,P=0.184)。结论﹑上消化道溃疡穿孔修补术后,患者的内镜检查及内科正规治疗依从率较低,长期严重并发症发生率较高。Objective To investigate the incidence of severe complications in patients with peptic ulcer perforation after simple closure operation.Methods All discharged 117 patients after perforated peptic ulcer simple closure from Jan 2010 to June 2014 were followed-up.Focusing on patients compliance to undergo endoscopic examination and radical H P treatment within 3 months after operation,whether giving up had habit such as smoking or drinking,whether using nonsteroidal anti-inflammatory drugs.Persisting ulcer symptoms and other complications such as reperforation,bleeding,obstruction,etc were recorded.Results Gastroscopy was performed in 22 cases(21.4%)within 3 months after operation,and only 5 cases received H P radical treatment.There were altogether 10 cases of severe complications developed during the period of followed-up,including 6 cases of pyloric obstruction,4 cases of reperforation,and 2 cases repeated ulcer bleeding.The average interval from perforation operation to the first serious complication was(24.8±5)months.Among them,2 cases of perforation and 1 case of repeated obstruction were treated surgically,the rest underwent conservative treatment.Compared with the severe complic ations group much less patients receving early postoperative gastroscopy have had such severe complications(23.1%vs.0,P=0.184).Conclusion After simple closure of upper gastrointestinal ulcer perforation,the low compliance rate of endoscopy and active medical treatment lead to high incidence of long-term serious complications.

关 键 词：消化性溃疡穿孔 胃镜检查 消化性溃疡出血 术后并发症 

分 类 号：R656.62[医药卫生—外科学]