胃十二指肠溃疡穿孔非手术治疗的临床观察

摘要

目的 探讨胃十二指肠溃疡穿孔(perforated gastroduodenal ulcer,PGDU)非手术治疗效果.方法 回顾性分析2008年1月至2015年1月深圳市福田区人民医院PGDU病人186例,按拟定的适应证选择非手术综合治疗,按临床标准评估疗效,治疗达标后通过早期胃镜检查确定穿孔病因.结果 本组186例PDGU病人中,全部经非手术治愈,无一例死亡.治疗期间接受胃镜检查177例(95.1%),确诊为胃十二指肠溃疡;未行胃镜检查确诊9例(4.9%).餐后穿孔需腹腔穿刺引流的比例(71.8%)比空腹穿孔需要穿刺引流的比例(5.5%)高,差异有统计学意义(P<0.05).腹腔积液与无腹腔积液平均发热时间[(4.2±0.6) d比(2.2±0.5) d)]相比较,差异有统计学意义(P<0.05);两者的平均住院时间[(8.2±0.8) d比(7.8±0.7) d)]相比较,差异无统计学意义(P>0.05).结论 非手术治疗PDGU是安全有效的,期间如果有腹腔积液,可选择腹腔穿刺引流.%Objective To evaluate the effect of non-surgical treatment for gastroduodenal perforation.Methods A retrospective analysis was performed on the gastroduodenal perforation patients suspected of benign ulcer in origin on hospital admission.Results Among 186 patients undergoing gastroscopy,177 patients were diagnosed as gastroduodenal ulcer,and there were no deaths during the treatment.The rate of abdominal puncture drainage for peritoneal effusion in postprandial perforation was higher than empty stomach perforation.Conclusions Modern comprehensive non-surgical treatment is effective for gastroduodenal perforation.Abdominal puncture drainage is needed for gastroduodenal perforation with peritoneal effusion.