Gastric and duodenal ulcer perforation repair

In the past, the traditional concept of perforation of gastric and duodenal ulcers was immediate surgical repair or resection. With the development of acute and abdomen treatment with integrated Chinese and Western medicine, this concept has changed, the rate of non-surgical treatment has gradually increased, and the indications for surgery have been gradually limited. Treatment of diseases: acute perforation of the duodenum of the stomach, duodenal ulcer, congenital absence, atresia and stenosis Indication According to the experience of Dalian Medical University and Tianjin Nantian Hospital in the treatment of acute abdomen, the indications for surgical treatment are as follows (including gastrectomy): 1. The patient's general condition is not good, accompanied by shock or heart, lung, liver, kidney and other important organ lesions, and peritonitis is gradually turning to severe. 2. Complex perforation (such as cancer, bleeding, obstruction) or suspected other acute abdomen requires immediate surgery. 3. Severe peritonitis, more peritoneal effusion, severe intestinal paralysis, abdominal distension and symptoms of poisoning. 4. According to the non-surgical treatment indication for 6 to 12 hours (generally no more than 12 hours), the symptoms and signs are not relieved or worsened. 5. Age 40 years of age or older, refractory ulcers with a long history, or malignant lesions suspected of gastric ulcer, and perforation after satiety, surgery may be considered. Preoperative preparation Patients with poor general condition should be properly preoperatively prepared (such as antibiotics, gastrointestinal decompression, correction of water, electrolyte imbalance, blood volume, etc.), and surgery can only be performed after the condition has improved. If the patient has developed toxic shock, surgery should be performed in time after 1 to 2 hours of active preparation. Surgical procedure 1. Position: supine position 2. Incision: generally use the upper abdomen incision; preoperative suspected gastric ulcer perforation, can be used on the left side of the rectus abdominis incision; suspected duodenal ulcer perforation, can be used right side of the rectus abdominis incision. Cut the peritoneum and drain the fluid in the abdominal cavity. 3. Suture perforation: perforation is mostly in the anterior wall of the stomach and duodenum. Fibrin exudate is often deposited in the perforation. Squeezing the stomach can cause liquid and air bubbles to escape, which is generally easy to find. Sometimes the perforation is covered by the omentum, liver, gallbladder, etc., and can be gently separated and revealed. If no perforation is found in the anterior wall, the gastric colon ligament should be cut and the posterior wall of the stomach examined. The small perforation of the surrounding tissue is not very hard. The medium thread can be used along the long axis of the stomach wall, and the perforation of the sarcolemma can be sutured 3 to 4 needles. If the duodenum is perforated, the suture should pass through the whole layer of the intestinal wall. . Then, carefully ligature one by one and close the perforation. The stitches are not cut temporarily. 4. Cover the omentum: Pull the omentum to the perforation to cover, and then loosely suture the suture. It is not advisable to ligature too tightly to avoid avascular necrosis of the omentum. 5. Sucking the fluid in the abdominal cavity: After checking the perforation and suturing properly, check and absorb the exudate and food residue in the abdominal cavity (especially under the liver and pelvis). 6. Stitching: suture the peritoneum, rectus abdominis sheath, subcutaneous tissue and skin by layer. For heavy pollution, a cigarette drainage or a soft rubber tube drainage should be placed in the abdominal cavity, and a rubber sheet should be placed under the skin for drainage.