目的 探讨胃十二指肠溃疡穿孔修补术后近期再穿孔影响因素.方法 回顾性分析三家医院近十年胃十二指肠溃疡穿孔修补术后近期再穿孔病例25例,随机抽样未发生近期再穿孔25例,对影响再穿孔的相关因素进行比较.结果 影响胃十二指肠溃疡穿孔修补术后近期再穿孔的危险因素有:高龄,年龄≥60岁;存在伴随疾病(糖尿病,肝硬化,肺心病,高血压);穿孔时间长(≥24h);穿孔直径大(≥1cm);穿孔周围存在明显瘢痕.结论 对于存在危险因素的病人,应改进手术方法,预防再穿孔.情况允许时,可作胃大部切除.发生再穿孔后,一般可经保守治疗治愈.%Objective To explore the influencing factors for reperforation after surgical repair of perforated gastroduodenal ulcer. Methods 25 patients with reperforation after repair of perforated gastroduodenal ulcer in three hospitals in the past ten years were analyzed retrospectively;and 25 patients without perforation were randomly selected. The influencing factors of reperforation were compared and then analyzed statistically using the Spss 13.0. P＜0.05 had significant differences. Results The high-risk factors for influencing reperforation were people aged 60 or older;coexiting diseases including diabetes mellitus,cirrhosis,cor pulmonale,and hypertension;prolonged perforation (equal to or longer than 24 hours);larger perforation (diameter equal to or longer than one centimeter);and obvious scars around the perforated area. Conclusions For the high-risk patients,surgical procedures should be improved to prevent reperforation. If the patient conditions are allowed,subtotal gastrectomy can be performed. The patients generally can be cured by palliative treatment after the occurrence of reperforation.
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