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摘要：
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摘要：目的 探讨肝硬化并发上消化道溃疡穿孔患者的手术治疗方式及疗效。方法 回顾性分析2009年6月
至2019年6月于首都医科大学附属北京地坛医院进行手术治疗的46例肝硬化并发上消化道溃疡穿孔患者的
临床资料。其中40例行穿孔修补术，6例行远端胃大部切除术。依据手术方式不同，将穿孔修补术患者
分为开腹组（18例）和腹腔镜组（22例），比较两组患者手术时间、术中出血量、术后排气时间、术后
住院时间及术后并发症。电话或门诊随访行穿孔修补术患者术后1～12个月胃镜结果。结果 开腹组与腹
腔镜组患者手术时间[（131.3 ± 21.7）min vs（85.7 ± 22.8）min]、术中出血量[（150.0 ± 40.8）ml vs
（40.0 ± 11.5）ml]、术后排气时间[（4.5 ± 1.3）d vs（2.8 ± 1.0）d]、术后住院时间[（28.1 ± 20.7）d vs（8.1 ±
1.8）d]及术后并发症[61.1%（11/18）vs 22.7%（5/22）]差异均有统计学意义（P均＜ 0.05）。行远端胃大
部切除术的6例患者均无严重并发症。随访40例穿孔修补术后患者，29例在术后1～12个月进行了胃镜检
查，其中3例溃疡未愈合，继续内科治疗后痊愈；3例十二指肠球部瘢痕伴狭窄，患者无症状；1例胃窦
溃疡患者术后1年复查溃疡癌变。结论 腹腔镜穿孔修补术更适用于肝硬化并发上消化道溃疡穿孔患者，
具有创伤小、手术时间短、出血量少及恢复快等优点。远端胃大部切除术可综合患者情况谨慎开展。
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Abstract: Objective To investigate the surgical treatment methods and curative effects of liver cirrhosis patients
complicated with perforation of upper gastrointestinal ulcer. Methods Data of 46 liver cirrhosis patients complicated
with perforation of upper gastrointestinal ulcer who underwent surgical treatment in Beijing Ditan Hospital, Capital
Medical University from June 2009 to June 2019 were retrospectively analyzed. There were 40 cases underwent
ulcer perforation repair and 6 cases underwent distal subtotal gastrectomy. According to surgical methods, patients
who underwent ulcer perforation repair were divided into open aortic surgery group (18 cases) and laparoscopic
group (22 cases), the operation time, intraoperative blood loss, postoperative exhaust time, postoperative hospital
stay and postoperative complications were compared between the two groups. Gastroscopy results of patients who
underwent ulcer perforation repair 1～12 months after surgery were followed-up by telephone or outpatient. Results
The differences of operation time [(131.3 ± 21.7) min vs (85.7 ± 22.8) min], intraoperative blood loss [(150.0 ±
40.8) ml vs (40.0 ± 11.5) ml], postoperative exhaust time [(4.5 ± 1.3) d vs (2.8 ± 1.0) d], postoperative hospital stay
[(28.1 ± 20.7) d vs (8.1 ± 1.8) d] and postoperative complications [61.1% (11/18) vs 22.7% (5/22)] of patients in
open aortic surgery group and laparoscopic group were statistically significant (all P ＜ 0.05). Patients (6 cases) who
underwent distal gastrectomy had no serious complications. Forty patients who underwent ulcer perforation repair
were followed up, among whom 29 cases recieved gastroscopy 1～12 months after operation, three of them were
not healed but recovered after medical treatment, another 3 cases were found duodenal scar with stenosis and without
asymptomatic. One case with gastric antrum ulcer was found canceration one year after operation. Conclusions
Laparoscopic ulcer perforation repair surgery is more suitable for patients with upper gastrointestinal ulcer due to
liver cirrhosis, with the advantages of less trauma, shorter operation time, less blood loss and faster recovery. Distal
gastrectomy can be carried out with caution based on the the condition of the patients.
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