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老年人潰瘍病急性穿孔外科治療19例體會

PCT與hs-CRP聯合檢測對老年胃十二腸潰瘍急性穿孔合并腹膜炎的診療價值

目的 探討血清降鈣素原（PCT）與超敏C反應蛋白（hs-CRP）聯合檢測對老年胃十二腸潰瘍急性穿孔合并腹膜炎的診療價值。 方法 選擇老年胃十二腸潰瘍急性穿孔患者共88例，所有患者于確診胃十二腸潰瘍急性穿孔使用抗菌藥物前同時檢測外周血PCT和hs-cRP水平，并同時進行白細胞計數和血培養。 結果 非膿毒癥組、輕度膿毒癥組和重度膿毒癥組患者的血清PCT及hs-CRP水平依次升高，3 組間差異有統計學意義（P＜0.01）。非膿毒癥組、輕度膿毒癥組和重度膿毒癥組白細胞計數依次升高，3 組間差異有統計學意義（P＜0.01）。非膿毒癥組血培養結果陽性率為 0；輕度膿毒癥組血培養結果陽性者 5 例，占全部血培養患者的5.68%；重度膿毒癥組血培養結果陽性者38例，占全部血培養患者的43.18%，3 組間的差異有統計學意義（P＜0.01）。 結論 PCTM與hs-CRP聯合檢測有助于老年胃十二腸潰瘍急性穿孔合并腹膜炎患者感染狀況的判斷以及指導抗菌藥物的使用。

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.

腹腔鏡闌尾切除術治療急性穿孔性闌尾炎的臨床療效分析及經驗體會

目的總結腹腔鏡闌尾切除術治療急性穿孔性闌尾炎的臨床療效及經驗體會。方法回顧性分析 2014 年 9 月至 2018 年 9 月期間上海交通大學醫學院附屬第九人民醫院北部普外科收治的 48 例行腹腔鏡闌尾切除的急性穿孔性闌尾炎患者的臨床資料。收集患者的術前資料、手術資料和術后相關資料，分析腹腔鏡闌尾切除術治療急性穿孔性闌尾炎的臨床療效。結果48 例患者中，有 2 例因腔鏡下縫合困難中轉開腹（4.2%），46 例順利完成腹腔鏡手術（95.8%）；手術時間（70±21）min，術中出血量（28±15）mL，術后肛門排氣時間（33±15）h；術后腹腔引流管前 2 d 的引流量較多，拔管時間為術后 3～5 d，平均 4 d；出院時間為術后 3～10 d，平均 5 d。術后第 1 天所有患者均有發熱，體溫較術前高，3 d 后體溫逐漸正常，白細胞計數也表現為同樣的趨勢。術后 15 例患者出現并發癥，其中 10 例切口感染，4 例腹腔感染，1 例腸梗阻，通過保守治療，所有患者均好轉出院，無再次手術患者。術后 48 例患者的隨訪時間為 3～6 個月，均未出現腹痛、腹脹等癥狀。結論腹腔鏡闌尾切除術治療急性穿孔性闌尾炎是安全可行的，值得推廣。