Kurygin A A, Peregudov S I, Gulua F I
Vestn Khir Im I I Grek. 1998;157(4):24-7.
An experience with surgical treatment of 1027 patients with perforated gastroduodenal ulcers was analyzed. Radical operations were performed on 541 patients (52.7%), palliative operations on 486 patients (47.3%). Total lethality was 7.5%, among them 13.2% after the palliative procedures, 2.4% after radical ones (p < 0.01). With all well-known risk factors (age older than 60 years, coexistent diseases, preoperative shock, time since the moment of perforation more than 24 hs, diffuse peritonitis etc.) the reliably lower lethality and less amount of early complications were noted after the bilateral truncal subdiaphragmatic vagotomy with dissection of the ulcer and pyloroplasty. The minimum volume of surgical interventions must be chosen in patients with critical general condition and terminal phase of intraperitoneal infection. Palliative operations (dissection and suture of the ulcer) are justified for perforating ulcers of the antral portion and body of the stomach against the background of risk factors.
对1027例胃十二指肠溃疡穿孔患者的手术治疗经验进行了分析。541例患者（52.7%）接受了根治性手术，486例患者（47.3%）接受了姑息性手术。总死亡率为7.5%，其中姑息性手术后为13.2%，根治性手术后为2.4%（p<0.01）。在所有已知的危险因素（年龄大于60岁、并存疾病、术前休克、穿孔后时间超过24小时、弥漫性腹膜炎等）中，双侧迷走神经干膈下切断术联合溃疡切除和幽门成形术后的死亡率显著降低，早期并发症数量也较少。对于全身状况危急和腹腔感染终末期的患者，必须选择最小的手术干预量。在存在危险因素的情况下，姑息性手术（溃疡切除和缝合）对于胃窦部和胃体部的穿孔性溃疡是合理的。
