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老年人溃疡病急性穿孔外科治疗19例体会

Evaluation of Ultrasound Guided Percutaneous Drainage for Acute Perforation of Gastroduodenal Ulcer in Elderly Patients . 

Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases.　In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.

PCT与hs-CRP联合检测对老年胃十二肠溃疡急性穿孔合并腹膜炎的诊疗价值

目的 探讨血清降钙素原（PCT）与超敏C反应蛋白（hs-CRP）联合检测对老年胃十二肠溃疡急性穿孔合并腹膜炎的诊疗价值。 方法 选择老年胃十二肠溃疡急性穿孔患者共88例，所有患者于确诊胃十二肠溃疡急性穿孔使用抗菌药物前同时检测外周血PCT和hs-cRP水平，并同时进行白细胞计数和血培养。 结果 非脓毒症组、轻度脓毒症组和重度脓毒症组患者的血清PCT及hs-CRP水平依次升高，3 组间差异有统计学意义（P＜0.01）。非脓毒症组、轻度脓毒症组和重度脓毒症组白细胞计数依次升高，3 组间差异有统计学意义（P＜0.01）。非脓毒症组血培养结果阳性率为 0；轻度脓毒症组血培养结果阳性者 5 例，占全部血培养患者的5.68%；重度脓毒症组血培养结果阳性者38例，占全部血培养患者的43.18%，3 组间的差异有统计学意义（P＜0.01）。 结论 PCTM与hs-CRP联合检测有助于老年胃十二肠溃疡急性穿孔合并腹膜炎患者感染状况的判断以及指导抗菌药物的使用。

腹腔镜阑尾切除术治疗急性穿孔性阑尾炎的临床疗效分析及经验体会

目的总结腹腔镜阑尾切除术治疗急性穿孔性阑尾炎的临床疗效及经验体会。方法回顾性分析 2014 年 9 月至 2018 年 9 月期间上海交通大学医学院附属第九人民医院北部普外科收治的 48 例行腹腔镜阑尾切除的急性穿孔性阑尾炎患者的临床资料。收集患者的术前资料、手术资料和术后相关资料，分析腹腔镜阑尾切除术治疗急性穿孔性阑尾炎的临床疗效。结果48 例患者中，有 2 例因腔镜下缝合困难中转开腹（4.2%），46 例顺利完成腹腔镜手术（95.8%）；手术时间（70±21）min，术中出血量（28±15）mL，术后肛门排气时间（33±15）h；术后腹腔引流管前 2 d 的引流量较多，拔管时间为术后 3～5 d，平均 4 d；出院时间为术后 3～10 d，平均 5 d。术后第 1 天所有患者均有发热，体温较术前高，3 d 后体温逐渐正常，白细胞计数也表现为同样的趋势。术后 15 例患者出现并发症，其中 10 例切口感染，4 例腹腔感染，1 例肠梗阻，通过保守治疗，所有患者均好转出院，无再次手术患者。术后 48 例患者的随访时间为 3～6 个月，均未出现腹痛、腹胀等症状。结论腹腔镜阑尾切除术治疗急性穿孔性阑尾炎是安全可行的，值得推广。