胃十二指肠溃疡穿孔47例临床诊治研究.docVIP

胃十二指肠溃疡穿孔47例临床诊治研究[摘要]目的 探讨胃十二指肠溃疡穿孔的治疗策略。方法 2008年7至2009年7月,我院共收治了47例胃十二指肠溃疡穿孔患者,通过他们的临床及随访资料,对治疗方法和效果进行回顾性分析总结。结果 非手术治疗10例中临床治愈9例,中转手术1例,单纯缝合修补术22例,行胃大部分切除手术15例。结论 非手术治疗是针对适应证患者的治疗手段,单纯缝合修补手术是治疗胃十二指肠溃疡穿孔的主要手段。 [关键词]胃十二指肠溃疡;穿孔;非手术治疗;胃大部分切除术 [中图分类号] R656.6+2[文章标识码]A[文章编号] Clinical Analysis of 47 Patients with Perforation Resulting from Gastric and Duodenal Ulcers Zhihui Song lianqiao center hospitalshaodong countyhunan province [Abstract] Objective To study the diagnosis and treatment strategies of perforation resulting from gastric and duodenal ulcer. method Our hosipital treated 47 patients with perforation resulting from gastric and duodenal ulcer during July 2008 to July 2009,according to the clinical data and follow-up data of 47 patients, the paper analyzed and retrospected the effect of different treatment methods. Results10 cases underwent non-surgical treatment, 9 cases were cured,1 case transit to surgical operation treatment.21 cases of them underwent simple repair of perforation,15 surgical removed of most part of stomach. ConclusionNon-surgical treatment is a kind of treatments for certain patients, simple repairing of perforation is the primary means of treatment methods. [Key Words] Gastric and duodenal ulcer; Perforation; non-surgical treatment; treatment of repairing laparoscopic 前言 胃十二指肠溃疡穿孔是极为常见的疾病,发病比较急、病情较重且变化快,需要及时诊治,延误治疗会错过最佳治疗时间,甚至危及患者的生命。[1]本院自2008年7至2009年7月共收治47例胃十二指肠溃疡穿孔患者,并对其中39例进行了随访,现将临床诊治和随访情况进行分析,总结如下。 1 临床资料 本组男34例,女13例;年龄最小21岁,最大78岁,平均年龄61岁;术前有明确胃病史的31例,无胃病史的16例;发病时间2小时～72小时,以12小时为界,12小时以内的38例,超过12小时的9例;穿孔部位:胃窦部21例,胃小弯13例,十二指肠穿孔13例,其中前壁11例,后壁2例;穿孔直径0.4～1.2cm,胃穿孔的直径要比十二指肠大;大部分胃十二指肠溃疡患者发病时腹部剧痛,本组41例,其中广泛性腹膜炎33例,局限性腹膜炎8例;腹腔穿刺阳性28例占59%(28/47);立位X线透视阳性38例占80%。 2 结果 穿孔至手术时间最短2小时,最长72小时,12小时以内手术38例。非手术治疗10例,其中1例中转手术治疗;单纯穿孔部位修补22例;行胃大部切除15例(BⅠ式8例,BⅡ3例)。47例经治疗均痊愈。术后有39例治疗好转后接受了正规抗溃疡治疗(洛赛克联合阿莫西林、克拉霉素),溃疡治愈率85%(33/39)。 3 讨论 3.1胃十二指肠溃疡穿孔的诊断 胃十二指肠溃疡穿孔的局部表现是位于胃十二指肠壁有圆形或椭圆形的缺损,由于肠壁缺损使胃肠内液进入腹腔,产生强烈的