摘 要：目的 研究胃穿孔行修补术和胃大部切除术的临床疗效。方法 回顾分析2016年10月～2017年10月在我院治疗的90例胃穿孔患者临床资料，依据手术方法将其分为修补组和切除组，各45例。切除组采用胃大部切除术，修补组采用修补术，对比两组患者临床疗效。结果 修补组治疗总有效率与切除组对比，差异无统计学意义（P>0.05）;修补组手术时间、住院时间短于切除组，术中出血量少于切除组，并发症发生率低于切除组，差异有统计学意义（P<0.05）;切除组复发率低于修补组，差异有统计学意义（P<0.05）。结论 胃修补术和胃大部切除术治疗胃穿孔均具有一定的疗效，修补术创伤小，手术时间短，出血量少，而切除术复发率低。两种手术方法各有优势，临床应依据患者具体情况合理选择。
关键词：胃穿孔;修补术;胃大部切除术
中图分类号：R656.61 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.05.034文章编号：1006-1959（2018）05-0103-02
Repair of Gastric Perforation and Subtotal Gastrectomy
ZHOU Jun
（Department of General Surgery，Zhongzang Hospital，Jiuzhaigou 623400，Sichuan，China）
Abstract：Objective To study the clinical effect of repair and subtotal gastrectomy for gastric perforation.Methods The clinical data of 90 patients with gastric perforation treated in our hospital from October 2016 to October 2017 were retrospectively analyzed. According to the operative method，the patients were divided into two groups：the repair group and the resected group，45 cases each group.The resection group was treated with subtotal gastrectomy，and the repair group with the repair operation.Comparison of clinical efficacy between the two groups was made.Results There was no significant difference in the total effective rate between the repair group and the resection group（P>0.05），the operative time，the hospitalization time and the amount of intraoperative bleeding in the repair group were shorter than those in the resection group，and the incidence of complications was lower than that in the resection group，the difference was statistically significant（P<0.05）.The recurrence rate in resection group was lower than that in repair group，the difference was statistically significant（P<0.05）.Conclusion Gastric repair and subtotal gastrectomy are effective in the treatment of gastric perforation.They have advantages of less trauma，shorter operation time，less bleeding，and lower recurrence rate of resection. Clinical selection should be based on the patient"s specific situation.
Key words：Gastric perforation;Repair;Subtotal gastrectomy
胃穿孔（gastric perforation）是胃潰疡常见的多发并发症，通常发病急，病情进展快，临床表现为穿孔部位或上腹部灼烧、似刀割剧烈疼痛，严重时会发生腹膜炎，造成死亡[1，2]。临床如果不及时有效治疗，会危及患者的生命安全。随着手术方式的多样化，选择合理的手术方式成为治疗的关键。临床中单纯修补术和胃大部切除术是主流的术式选择，但是两者的临床疗效和安全性备受争议[3]。本文结合我院治疗的90例胃穿孔患者临床资料，研究胃穿孔行修补术和胃大部切除术临床效果，现报告如下。