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目的探讨老年胃、十二指肠急性穿孔临床特点及诊治经验。方法回顾分析124例老年胃、十二指肠急性穿孔患者临床资料及治疗结果。结果124例60岁以上老年胃、十二指肠急性穿孔患者,其中胃溃疡40例、十二指肠球部溃疡62例,胃癌22例。无突发性上腹疼、“板状腹”分别占45.2%、58.1%。白细胞计数≤10×109/L占96.0%。治愈112例,死亡12例,病死率9.7%(其中死于休克6例,肺部感染4例,多器官功能衰竭2例)。误诊率21.8%。并发症:肺部感染26例,上消化道出血15例,中毒性休克15例,切口裂开12例,多器官功能衰竭4例,腹腔感染5例。结论①老年胃、十二指肠急性穿孔缺乏典型的症状、体征,炎性反应的程度与白细胞的升高不成比例;②老年患者并发症多,易被并发症之症状掩盖而出现误诊。
Objective To investigate the clinical features and diagnosis and treatment of elderly patients with acute gastric and duodenal perforation. Methods Retrospective analysis of 124 cases of elderly patients with acute perforation of the duodenum clinical data and treatment results. Results 124 cases of elderly patients over the age of 60 stomach, duodenal acute perforation patients, including 40 cases of gastric ulcer, 62 cases of duodenal ulcer, gastric cancer in 22 cases. No sudden upper abdominal pain, “flat belly ” accounted for 45.2%, 58.1%. White blood cell count ≤10 × 109 / L accounted for 96.0%. 112 cases were cured, 12 died, the case fatality rate was 9.7% (6 cases died of shock, 4 cases of lung infection and 2 cases of multiple organ failure). Misdiagnosis rate of 21.8%. Complications: pulmonary infection in 26 cases, 15 cases of upper gastrointestinal bleeding, toxic shock in 15 cases, 12 cases incision split, multiple organ failure in 4 cases, 5 cases of abdominal infection. Conclusion ① The elderly patients with gastric and duodenal acute perforation lack typical symptoms and signs, and the degree of inflammatory reaction is disproportionate with the increase of leukocytes; ② There are many complications in elderly patients and are easily misdiagnosed as symptoms of complications.