Chernookov A I, Naumov B A, Kotaev A Iu, Belykh E N, Ramishvili V Sh, Timoshin N N, Barkalin V V
Khirurgiia (Mosk). 2007(6):34-9.
Results of surgical treatment of 782 patients with perforated gastric and duodenal ulcers are analyzed. Gastric ulcers of I type were diagnosed at 86 (10.9%) patients, prepyloric and pyloric ulcers - at 441 (56.4%), duodenal ulcers - at 255 (32.6%) patients. Perforation was combined with bleeding and stenosis at 24 (3.1%). Palliative operations have been performed at 172 (22.0%) patients, stem vagotomy with ulcer excision and pyloroplasty - at 58 (7.4%), various types of stomach resection - at 54 (6.9%), proximal gastric vagotomy with excision of gastric, pyloric or duodenal ulcer - at 77 (9.8%), proximal gastric vagotomy with excision or suturing of ulcer and pyloro- or duodenoplasty - at 421 (53.8%) patients. The rate of postoperative complications after proximal gastric vagotomy was 3.6%, after stomach resection - 18.2% (p<0.01). Early postoperative complications after vagotomy with ulcer excision and pyloroplasty were diagnosed at 8.3%, after stomach resection - at 18.2% patients (p<0.01). The quality of patients life was higher after organ-saving operations. Proximal gastric vagotomy with excision of ulcer and pyloro- or duodenoplasty should be regarded as operation of choice at perforated duodenal ulcers.
分析了782例胃十二指肠溃疡穿孔患者的外科治疗结果。I型胃溃疡在86例（10.9%）患者中被诊断出，幽门前和幽门溃疡在441例（56.4%）患者中被诊断出，十二指肠溃疡在255例（32.6%）患者中被诊断出。穿孔合并出血和狭窄的有24例（3.1%）。172例（22.0%）患者进行了姑息性手术，溃疡切除加幽门成形术的迷走神经干切断术58例（7.4%），各种类型的胃切除术54例（6.9%），胃、幽门或十二指肠溃疡切除的近端胃迷走神经切断术77例（9.8%），溃疡切除或缝合加幽门或十二指肠成形术的近端胃迷走神经切断术421例（53.8%）患者。近端胃迷走神经切断术后的术后并发症发生率为3.6%，胃切除术后为18.2%（p<0.01）。溃疡切除加幽门成形术的迷走神经切断术后早期术后并发症在8.3%的患者中被诊断出，胃切除术后在18.2%的患者中被诊断出（p<0.01）。保器官手术后患者的生活质量更高。溃疡切除加幽门或十二指肠成形术的近端胃迷走神经切断术应被视为十二指肠溃疡穿孔的首选手术。
