【摘要】 目的探讨消化性溃疡急性穿孔(APPU)的诊断和治疗方式选择。方法750例APPU患者非随机地接受了A(非手术疗法)、B(单纯修补术)、C(胃大部切除术)不同的治疗方法,A组186例,B组296例,C组268例,治疗后进行了5~12年的随访。结果获得随访609例,A组152例,B组243例,C组214例。术前X线确诊率76%,B超为92.2%,腹腔穿刺为85%,胃大部切除术的近期并发症与单纯修补术或非手术治疗相比无显著差异,但远期疗效(复发率)却有显著差异,A、B、C三组5年溃疡得发率分别为60.5%、64.2%、3.3%。结论术前X线、B超和腹腔穿刺联合应用可明显提高APPU的确诊率,单纯修补术应严格掌握适应症,胃大部切除术在解决穿孔的同时又去除了溃疡病灶和泌酸环境,达到了根治目的,是治疗APPU较理想的手术方式。更多还原

【Abstract】 Objective To evaluate the diagnosis and treatment ways of acute perforation of peptic ulcer (APPU) for improving levels of the diagnosis and treatment. Methods 750 patients with APPU were treated with three different methods, respectively. Method A was non-operative treatment (group A, 186 cases), and method B was simple closure operation (group B, 296 cases), and method C was subtotal gastrectomy (group C, 268 cases).Following up in 5 to 12 years after treatment. Results 609 patients were followed up (group A 152, group B 243 and group C 214). The correct diagnostic rates of X-ray was 76%, B-ultrasoned was 92.2% and abdominocentesis was 85%. The early complications in subtotal gastroctomy group comparing with simple closure operation group and non-operative treatment group were no significant different, but the long-term effect ( recurring rate) was much better than that of other two groups. The recurring rate in group A was 60.5%, in group B was 64.2%, and in group C was 3.3%. Conclusion Combining use of X-ray, B-ultrasoned and abdeminocentesis can apparently improve the diagnosis rates. Simple closure operation should be controled strictly in indication. Subtotal gastrectomy can remove of the ulcer and the acid secretion and is a more popular choice for the patients with APPU.更多还原