摘要
目的 比较非手术与手术治疗穿孔性十二指肠溃疡的疗效。方法 对我院 1995年 1月至 1999年 12月期间 ,所收治的 2 5 4例穿孔性十二指肠溃疡病人的临床资料进行回顾分析。结果 非手术治疗 6 8例 ,1例出现腹腔脓肿 ,无一例再穿孔和死亡 ,3个月后溃疡愈合率为 92 .5 % ;手术治疗 186例 ,其中 10 2例行穿孔修补术 ,无一例出现腹腔脓肿 ,1例出现幽门梗阻需再行胃大部切除术 ,3个月后溃疡愈合 94 .1% ,与非手术治疗无明显差异 ,另外 84例行胃大部切除术 ,出现残端漏 2例 ,腹腔脓肿 1例。结论 急性十二指肠溃疡穿孔能自行闭合 ,以非手术治疗更合理和安全 ,通过使用抗生素、质子泵抑制剂或H2 受体阻止剂联合药物治疗 ,溃疡是可治愈的。不能自行闭合的急性穿孔 ,选择单纯修补可降低手术并发症 ,术后配合内科治疗也可达到溃疡治愈目的。慢性十二指肠溃疡穿孔 ,往往伴有溃疡周围疤痕多、胼胝状溃疡、幽门梗阻、病史长、症状严重反复发作等因素 ,即使穿孔超过 12h ,仍可以选择“溃疡确定性外科”治疗。
Objective To compared the effectiveness of non operation versus operation for perforating duodenal ulcer. Methods A retrospective study of 254 patients with perforating duodenal ulcer between Jan. 1995 and Dec. 1999 was made.Results Among the 68 patients receiving non operative treatment, one case suffered from an intra abdominal abscess and no reperforation and death occur. The curative rate was 92.5% after 3 months. Of the 186 patients receiving operation, 102 underwent suture of performation. Pylorochesis occurred in 1 case and subtotal gastrectomy was made. The curative rate was 94.1% after 3 months. Of the remaining 84 cases receiving subtotal gastrectomy, 2 were subjected to duodenal stump fistula and one to an intra abdominal abscess.Conclusions Non operative treatment is more reasonable and safe ofr acute perforating duodenal ulcer which can be healing spontaneously. For those perforations unable to be closed spontaneously, simple suture of performation could reduce the operative complication.
出处
《腹部外科》
2002年第1期29-30,共2页
Journal of Abdominal Surgery
