沈象吉

[摘要] 目的 探討胃大部分切除术与单纯修补术治疗急性胃穿孔的疗效比较。方法 方便选择2016年3月—2018年1月收治的90例急性胃穿孔患者，据术式分组。对照组开展胃大部分切除术治疗，观察组行单纯修补术治疗。比较两组急性胃穿孔手术治疗效果;手术全程所需的时间、手术过程出血量、平均住院时间、术后开始进食流食时间;手术前后患者生活质量状况QOL评分;手术并发症发生率，手术后复发率。结果 观察组急性胃穿孔手术治疗效果45例（100.00%）高于对照组35例（77.78%）（χ2=11.250 0，P<0.05）;观察组手术全程所需的时间、手术过程出血量、平均住院时间、术后开始进食流食时间（42.12±12.13）min、（85.61±4.13）mL、（6.27±0.42）d、（24.25±3.13）h优于对照组（t=9.263、9.127、8.734、10.114，P<0.05）;手术后观察组生活质量状况QOL评分优于对照组（P<0.05）。观察组手术并发症发生率4例（8.89%）少于对照组11例（24.44%）（χ2=3.920 0，P<0.05）。对照组复发率2.22%低于观察组20.00%（χ2=3.844，P<0.05）。结论 急性胃穿孔患者行单纯修补术疗效肯定，可有效去除病变，减少并发症，改善生存质量，减少术中创伤，缩短手术时间和住院时间，术后胃肠道恢复快，近期效果肯定，但远期复发率高于胃大部分切除的患者。

[关键词] 胃大部分切除术;单纯修补术;急性胃穿孔;疗效

[中图分类号] R656          [文献标识码] A          [文章编号] 1674-0742（2018）08（c）-0004-03

Comparison of Curative Effect between Major Gastrectomy and Hernia Repair on Acute Gastric Perforation

SHEN Xiang-ji

Department of General Surgery， People's Hospital of Guangrao County， Guangrao， Shandong Province， 257300 China

[Abstract] Objective To compare the curative effects of gastrectomy and hernia repair on acute gastric perforation. Methods 90 patients with acute gastric perforation from March 2016 to January 2018 were convenient selected according to surgical method. The control group underwent major gastrectomy and the observation group underwent simple repair. The effect of surgical treatment of acute gastric perforation was compared between the two groups; the time required for the entire operation， the amount of blood loss during the operation， the average length of stay， and the time of starting a liquid diet after the operation; the quality of life status， QOL scores; and the incidence of surgical complications， the recurrence rate after surgery of patients before and after surgery were compared. Results The therapeutic effect of acute gastric perforation in observation group was 45 cases（100.00%） higher than that of control group 35 cases （77.78%） （χ2=11.250 0， P<0.05）. The time required for the entire operation in the observation group， the amount of bleeding during the operation， the average length of stay， postoperative results showed that （42.12±12.13）min， （85.61±4.13）mL， （6.27±0.42）d， and （24.25±3.13）h were better than the control group at the start of feeding and eating（t=9.263，9.121，8.734，10.114，P<0.05）; The QOL score was better than that of the control group（P<0.05）. The incidence rate of surgical complications in the observation group 4 cases（8.89%） was less than the control group 11 cases（24.44%）（χ2= 3.920 0， P<0.05）. The recurrence rate in the control group was 2.22% lower than that in the observation group 20.00%（χ2=3.844， P<0.05）. Conclusion The curative effect of the repair of acute gastric perforation is positive， it can effectively remove the lesions， reduce the complications， improve the quality of life， reduce intraoperative trauma， shorten the operation time and length of stay， postoperative gastrointestinal tract recovery， the recent results are positive， but the long-term recurrence rate is higher than that of patients with a major part of the stomach.

[Key words] Gastric major resection; Hernia repair; Acute gastric perforation; Efficacy

急性胃穿孔是一种常见的临床疾病。 近年来，急性胃穿孔的发病率由于生活不规律，精神紧张，节奏加快，饮食不当等因素逐年增加，严重影响了患者的生活质量[1-2]。手术是有效治疗急性胃穿孔的首选方法。 目前推荐的手术方法有简单的修复和切除方法等。该研究方便选择2016年3月—2018年1月收治的90例急性胃穿孔患者，据术式分组，分析了胃大部分切除术与单纯修补术治疗急性胃穿孔的疗效，现报道如下。

1  资料与方法

1.1  一般资料

方便选择90例急性胃穿孔患者，据术式分组。观察组男30例，女15例;年龄32～79岁，平均年龄（46.78±2.22）岁。对照组男28例，女17例;年龄31～77岁，平均年龄（46.41±2.02）岁。该研究所选病例经过伦理委员会批准，患者或家属知情同意。两组一般资料差异无统计学意义（P>0.05）。

1.2  方法

对照组开展胃大部分切除术治疗，在硬膜外麻醉下，在右上腹直肌上做切口，并探查穿孔。……