不同手术方法治疗胃十二指肠溃疡穿孔的疗效比较

摘要

目的:探讨胃十二指肠溃疡穿孔患者不同手术方法的疗效及并发症与远期复发率情况.方法:对2002年1月～2006年1月住院治疗的胃十二指肠溃疡穿孔患者根据手术方法不同分为A组30例(单纯缝合修补术),B组26例(胃大部分切除术及高选择性迷走神经切除加修补术),比较手术患者各项观察指标情况,对两组患者溃疡愈合率以术后及随访不同时间的复发率情况进行比较.结果:A组的手术时间[(75.2±10.1)min]、术中出血量[(82.6±11.6)ml]、术后下床活动时间[(32.4±2.4)h]、住院时间[(9.0±3.2)d]均明显短于B组[(95.2±20.4)min、(126.6±13.1)ml、(72.7±25.0)h、(14.0±2.8)d](均P＜0.05).A组远期并发症的发生率(6.67%)低于B组(26.92%)(P＜0.05),A组溃疡愈合率(93.33%)明显高于B组(88.50%)(P＜0.05),随访3年时,A组溃疡复发率(6.67%)明显低于B组(11.54%)(P＜0.05).结论:单纯缝合修补术、胃大部分切除术及高选择性迷走神经切除加修补术两种术式均具有较好的疗效,但单纯缝合修补术的手术时间短、术中出血少、患者恢复快、住院时间短、术后并发症发生率低,随访复发率低,疗效优于其他手术方式,值得推广和应用.%Objective: To evaluate the efficacy of different surgical techniques treated gastric ulcer perforation, and to compare the complications and long-term recurrence rate. Methods: According to the choice of surgical methods, the hospitalization patients from January 2002 to January 2006 were randomly divided into group A (30 cases, simple suture)and group B (26 cases, gastric resection and the most highly selective vagotomy plus repair), the observed indicators of the patients were compared, and the ulcer healing rates and the relapse rate after following up at different times were compared. Results: The operative time [(75.2±10.1)min], blood loss [(82.6±11.6)ml], postoperative ambulation time [(32.4±2.4)h], length of hospital stay [9.0±3.2)d] of group A were significantly shorter than group B [(95.2±20.4)min, (126.6±13.1)ml,(72.7±25.0)h, (14.0±2.8)d], the differences were statistically significant (all P＜0.05). Group A of long-term complication rate (6.67％) was lower than group B (26.92％) (P＜0.05), group A of ulcer healing rate (93.33％) was higher than group B (88.50％) (P＜0.05). After followed up 3 years, the ulcer recurrence rate of group A (6.67％) was lower than the group B (11.54％) (P＜0.05). Conclusion: Simple suture, resection of the stomach and most highly selective vagotomy plus repair of two procedures have better efficacy, but the simple suture has the shorter operative time, less bleeding, faster recovery of patients, shorter hospital time, a low incidence of postoperative complications, follow-up recurrence rate is lower, more effective than other surgical procedures, should be promoted and applied in the clinic.