Do not perform the operation to treat _'s treatment in stomach duodenum perforated ulcer

Do not perform the operation to treat _'s treatment in stomach duodenum perforated ulcer
Zou is intelligent Liu YuanZhou 2005-12-13 13:49:28 Chinese medical research magazine Number 7 of Vol. 3 of July of 2003

It is one of the complications of ulcer that gastroduodenal ulcer is acute to punch, clinic is seen more. Two kinds of methods of treatment that mainly there are surgery treatments and not perform the operation in therapeutic method at present. Punch commonly used operation to the intersection of ulcer and disease method excise skill mostly for stomach and nervus vagus cut off add the intersection of stomach and the intersection of sinus and excise or the intersection of the pylorus and shaping skill [1] ,Treating and can make ulcer get the thorough treatment to punch at the same time. But in this case there is peritonitis, some inflammation of pathological change edema, organizing fragily and healing ability badly, it is very risky, postoperative apt to present the recent complication to implement the above-mentioned operation, for instance: Bleed, break at incomplete end of the duodenum, infects, obstructs, postoperative acute pancreatitis and long-term complication: Pour out syndrome, nutrition, supersession obstacle, alkaline backflow gastritis, edge ulcer, incomplete gastric carcinoma,etc.. Case that digestive tract punches on a large number of treatment treatments that the ones that adopt and combine traditional Chinese and western medicine at home at present do not perform the operation, and make the good near long-term result and considered to be a feasible effective method [2] . According to the national therapy of combining traditional Chinese and Western medicine acute abdomen experience exchanging meeting materials of 1995, report 2234 treat experience, perform the operation generally treatment 50%- 80%, mortality 3% about on average together, complication incidence 7% about on average, perform the operation at a specified future date to follow up a case by regular visits to, observe behind the treatment, long-term curative effect is satisfied. Combine traditional Chinese and western medicine the intersection of acute abdomen and the intersection of research institute and one 328 of materials of report according to Tianjin, 2- followed up a case by regular visits to in 14, 256 examples follow up a case by regular visits to, following up a case by regular visits to rate is 78.05%, among them clinical symptom belongs to 119 well person, account for 46.48%, getting fair 93, account for 36.33%, belong to 44 well person, account for 17.19%, whom mirror check have 76 examples make, follow up a case by regular visits to, among them, the intersection of ulcer and 43 of healing etc., account for 56.58%, there are 13 examples that are found for the acute watch shallow ulcer in the over 33, and obstinate ulcer person has 20 examples only, accounts for 26.32%, according to these materials, ones that can be thought to combine traditional Chinese and western medicine do not perform the operation the treatment can yet be regarded as a feasible and effective treatment. With H 2 Receptor the intersection of blockade and pharmaceutical and the intersection of proton and the intersection of pump and inhibitor push away new while being constant, stomach duodenum perforated ulcer does not performed the operation non- the treatment has already become one of the important therapeutic method at present.
1 knows strictly that adapts to the card
Gastroduodenal ulcer is acute to punches and does not perform the operation the treatment must know strictly that adapt to the card, we think the person who accords with following several points can use and does not perform the operation to treat: Strong, the age is not over 55 years old; Punch on an empty stomach; Time is less than 24h; Abdominal cavity ooze little liquid, can't take out or not difficult to take out and less than 5ml, percussion mobility voiced sound obvious; Diaphragm mostly single side or dual less side from low reaches to gas; There are no diabetes and liver renal function not congruent complication person; Combine the belly Ultrasonography B in order to get rid of acute cholecystitis and acute appendicitis.
The treatment is a continuous course that 2 does not perform the operation
2.1 Prohibit the drinking water, the unobstructed purpose is to prevent the content thing of intestines and stomach from continuing seeping in the abdominal cavity that the intestines and stomach reduce pressure continuously, make the intestines and stomach in hollow state, closing by oneself and peritonitis takes a favorable turn so as to punch, nasogastric tube lasting negative pressure attract or the intersection of 50ml and empty needle release, inhale gastric juice once and a half hours while being every continuously, check and keep stomach tube to be unobstructed at any time, should adjust position or develop the stomach tube with the aseptic physiological saline on a small quantity while being unobstructed, until the rectum it is angry to arrange, the gurgling sound returns to normal, the physical sign of peritonitis is obviously lightened, time is generally 2- 6 days that the intestines and stomach reduce pressure.
2.2 Half a seat makes the pelvis in low order the most, even if the abdominal cavities can't be totally absorbed to more ooze the liquid by oneself, can also enable its gathering in the pelvis, so that the anaphase pelvis is guided, preventing from and is infected with under the diaphragm and abscess among the intestines.
2.3 Keep water electrolyte balanced and supplying nutrition Generally adopt " Amino acid- Glucose of China's density- The fat " The system offers intravenous high nutrition, the heat source is offered with glucose and fat milk, and props up chain amino acid for compound amino acid in nitrogen source. The card of average every fever for sun is 1500- 2000kcal, the liquid total amount 3000- 3500ml, the above should depend on the condition is added or subtracted. Check and the analysis situation of vim and vigour according to biochemistry, adjust the supply electrolyte and mend the acid treatment [3] .
2.4 Antibiotic and inhibiting the gastric acid to secrete medicines and employ antibiotic to generally adopt antibiotic + the first nitre thiazole 250ml treatment of wide table, generally employ for 4- 6 days continuously, suppress the gastric acid to secrete, the medicine resists first cyanogen miaow guanidine 0.6- 0.8g or proton pump inhibitor Lip river match gram 40mg of pharmaceutical to add the daily vein of liquid to import short of moneyly with H 2 receptors, oral administration or west rice is taken orally for 3 times of man 0.4g1 day to change into a safe stomach beautiful 800mg every night after eating, the above-mentioned medicines can depend on patient's economic conditions to choose.
2.5 The gurgling sound of therapy of combining traditional Chinese and Western medicine is faint or person who doesn't have gurgling sound, can cooperate with the acupuncture therapy, main point pivot, closing inside, 1.5 kilometers of feet of door of Wan, roof beam, day in China, among them close inside, 1.5 kilometers of feet are an important point. Generally once 30- 60min, can also stimulate with the electricity, 2 times a day, the general patient passes acupuncture 1- 3 times, can make it relieve not to suffer from abdominal pain, belly muscle disappear intensely, the gurgling sound resumes. The aforesaid treat behind the 48- 72h can offer, rush down, down decoction is for instance big the intersection of Radix Bupleuri and soup,etc., prescription this have, resume the intersection of intestines and stomach and function alsoing, positive role of restraining the fungus and sterilizing and promoting the abdominal cavity to ooze the liquid and absorb etc.. Patient resume, can pull out the stomach tube defecate, rank angry, begin to enter the diet of liquid, body temperature return to normal in the about 80% 3 day such as patient treat, through being above-mentioned, about 90% more than 5 patient, the physical sign of peritonitis disappears in the 6 day.
2.6 Ulcer the intersection of disease and the intersection of treatment and issues of above-mentioned acute disease behind the issue, should enter the intersection of ulcer and the intersection of disease and the intersection of treatment and issue, the general surgeon punches to ulcer after patient acute one cures and leaves hospital, continue treating on later stage to neglect ulcer, thus ulcer punches again complication of bleeding etc. occurs now and then [4] . Promote ulcer to recover and have proton pump inhibitors if Lip river match grams and H to equal to medicines at present 2 The receptor resists pharmaceuticals such as first cyanogen miaow guanidine,etc. short of moneyly. In order to prevent ulcer from recuring, must eliminate spiral shell's bacillus of pylorus, with bismuth salt, furan thiazole ketone, furan pyridine, hydroxy ammonia benzyl penicillin, first nitre thiazole and gentamicin,etc. in the oral medicine, there is higher removing rate [5] . Often adopt and unite the treatment three times at home at present: Aomei draws thiazole + citron acid bismuth + hydroxy ammonia benzyl penicillin once ' Tetracycline) Or first cyanogen miaow guanidine + citron acid once bismuth + hydroxy ammonia benzyl penicillin ( Tetracycline) . The former's course of treatment is short, the cure rate is high, but the medicine price is expensive; And the latter's course of treatment is long, but the medicine price is extremely low, can choose according to patient's economic conditions.
3 avoids misdiagnosing gastric carcinoma and punching
In order to avoid misdiagnosing gastric carcinoma to punch the case delays treating, while choosing the case, have illness coming on the intersection of mean age and characteristic over 40 and report gastric carcinoma punch mean age is 56.5 year old at home according to of our country gastric carcinoma, it is characteristic of 53.9- 62.5 years old abroad [6] ,To older to punch patient, except that not performing the operation strictly, the treatment adapts to the card, consult the gastroscope or barium meal inspection previously as an index.
4 perform the operation therapeutic complication and prevent and cure
The complication incidence of the treatment is 5%- 7% that ulcer punches and does not perform the operation, common complication is abdominal cavity's abscess and stomach retention, abdominal cavity abscess, until diaphragm lay abscess to be most many, abscess and pelvis abscess relatively more rare among the intestines, form diaphragm lay abscess and it accumulates reasons of liquid to be as follows, under the diaphragm Adapt to the card and choose improperly, take place in the treatment condition aggravate repeatedly, except that minority infect with the intersection of symptom and can adopt, perform the operation non- the treatment method is observed and treatedding light to treatment, abdominal cavity of abscess, generally should guide or develop through the intersection of drainage tube and abdominal cavity in early days, law this can puncture by fixed position until supersonic wave check guidance. Patient perform the operation generally treatment appear the stomach empty the obstacle while being about 1 week, his reason is a inflammation edema adhesion, the stomach wriggles badly and the pylorus is opened and closed and lacked proper care, the treatment can mostly be relieved through not performing the operation, only a few form the pylorus for a long time narrowly to need surgery to treat after all.
References
A Wu Jieping, Qiu FaZu. Surgery of team of four horses of the Huang 's. Sixth. Beijing: People's Health Publisher, 1999, 1002-1012.
2 Wu, in being salty, the yellow right of shining. Surgery practises the belly. Second. Beijing: The scientific and technological publishing house of Chinese medicine, 1997, 4473.
3 spring profit Xue. It is not to perform the operation to treat that gastroduodenal ulcer is acute to punch. Belly surgery, 1998, 210.
4 the intersection of sesame and field Zheng. Peptic ulcer. Beijing: People's Health Publisher, 1998, 453.
5 the intersection of discipline and case, the intersection of Li and one ring. Modern surgical disease diagnostics and treating. Tenth. Beijing: People's Health Publisher, 1998, 494.
6 gentle swallows, Zhu XueJun. Modern ordinary surgery make a diagnosis manual. Beijing: Beijing Medical University, China Concord Medical Science University unite one edition of societies, 1998, 259.
Author's unit: 1 334400 hospitals of outskirts of Jiangxi Province Yi open county
2 branches of general hospital of Military Area Command of Beijing
(Accept draft date: 2003-01-06)

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