目的 探讨两种不同手术方式治疗良性急性胃十二指肠溃疡穿孔的临床效果.方法 将我院132例良性急性胃十二指肠溃疡穿孔患者分为两组,A组90例采用单纯穿孔修补术加抑酸、根除幽门螺杆菌治疗;B组42例行胃大部切除,观察并比较两组的治疗效果.结果 132例患者均治愈出院,随访3～10年,均未见再穿孔及其他严重并发症.术后切口感染发生率B组明显高于A组(P＜0.05);内镜溃疡复发率、溃疡症状复发率B组均高于A组,但差异无统计学意义(P＞0.05);两组术后Visick 改良分级比较,A组明显优于B组,差异有统计学意义(u=2.402,P＜0.05).结论 单纯穿孔修补术加抑酸、根除幽门螺杆菌治疗,操作简单、创伤小、并发症少、远期疗效好,可作为良性急性胃十二指肠溃疡穿孔治疗的首选方式.%Objective To investigate the clinical effect of two operations in treating cases with acute and benign perforation of gastroduodenal ulcer. Methods 132 cases with acute and benign perforation of gastroduodenal ulcers in our hospital were divided into group A ( 90 cases ) and group B ( 42 case ), the former being treated with repair of perforation combined with acid suppression and helicobacter pylori eradication, while the latter being treated with subtotal distal gastrectomy. The treatment effects of both were observed and compared. Results All cases in the two groups were cured and discharged from hospital and didn't suffer from any recurrence and severe complications in the 3 ~ 10 years of follow - up, but the incidence rate of postoperative wound infection in group B was obvious higher than that in group A ( P <0. 05 ), and it was also the same with the incidence rate of endoscopic ulcer and ulcer symptom, but no significant difference were found ( P >0. 05 ). According to modified Visick grading score criteria, the grading situation in group A was superior to that in group B with significant difference ( u = 2. 402, P <0. 05 ). Conclusion The treatment of repair of perforation combined with acid suppression and helicobacter pylori eradication possess many good functions such as simple manipulation, less tuouma, few postoperative complications and a good long term therapeutic efficacy and so on, which can be the preferred manner to treat cases with perforation of gastroduodenal ulcer.
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