Clinical Study On The Treatment Of Gastric Perforation In Different Periods By Subtotal Gastrectomy

Objective:To investigate the treatment of patients with acute gastroduodenal perforation undergoing gastrectomy in different periods of time.With the early postoperative enteral nutrition support,the efficacy of the two groups was analyzed to provide a safe,reliable and effective method for the treatment of acute gastroduodenal perforation.Methods:A total of 86 cases of acute gastroduodenal perforation with major gastrectomy admitted to the General Surgery Department of The Affiliated Hospital of Inner Mongolia University for Nationalities from May 2013 to September 2018 were collected as the research objects.Patients with perforation time within 12 hours received most gastrectomy as the control group,and patients with perforation time within 12 to 24 hours received most gastrectomy as the research group.Enteral nutrition was started in the two groups 24 hours after surgery.Cases were grouped according to the requirements.The control group,i.e.,perforation within 12 hours,had 40 cases(7 females and 33 males)with an average age of(46.31±6.88)years,while the study group,i.e.,perforation within 12-24 hours,had 46 cases(8 females and 38 males)with an average age of(47.12 ± 7.01)years.By collecting two groups at:A.Preoperative:1.General clinical data(age,sex ratio,personal history,body mass index,etc.).2.Biochemical immune data(liver function,renal function,C-reactive protein,procalcitonin)and blood routine examination(leukocyte,neutral particle ratio,etc.).B.Intraoperative:comparison of abdominal flushing time,intraoperative blood loss,and operative time.C.postoperative:1.Reexamination of blood routine,liver function,renal function,C-reactive protein,procalcitonin.2.Postoperative activity time out of bed,exhaust time,gastric tube pulling time,eating time,drainage tube pulling time,days in hospital.3.Postoperative adverse events and complications:incidence of incision infection,fever,peritoneal effusion,septic shock,complications(stump or anastomotic leakage and death).Statistical software was used to analyze the differences between the two groups.Result:The results showed that:A.There was no significant difference in general clinical data before the operation;there were significant differences in albumin,inflammation-related factor C-reactive protein,procalcitonin,white blood cell count,and neutrophil ratio(P<0.05)before the liver function test,and the inflammatory responses of the two groups were significantly different and comparable.B.The average operative time in the study group was(125.36±25.39)min,while the average operative time in the control group was(110.41±0.45)min,showing a difference,indicating that the operative difficulty in the 12-24 hours perforation group was greater than that in the 12 hours perforation group.In the other group,the duration of intraoperative abdominal flushing was 35.78±5.89 min in the study group compared with 27.33±4.04 min in the control group,indicating that the perforation time was long and the abdominal cavity was heavily polluted,so it was difficult to rinse,and the duration of intraoperative abdominal flushing was long.C.Early postoperative review of liver function found that there was a difference between the two groups in albumin and prealbumin.After early increase of enteral nutrition,the study group recovered quickly.In terms of postoperative daily management,there was no significant difference in postoperative exhaust time,out-of-bed activity time,postoperative gastric tube extubation and eating time between the two groups(p>0.05).In terms of length of hospital stay,there was no significant difference between the 12-hour perforation group(10.84±1.85)d and the 12-24 hour perforation group(11.29±1.98)d.There were ? cases of postoperative fever in the observation group and 10 cases in the control group.There was no significant difference between the two groups(p>0.05),showing no statistical significance.In terms of mortality,there were 2 deaths in both groups,and a small number of cases did not indicate a difference.Conclusion:With the development of the concept of rapid rehabilitation medicine,enteral nutrition is applied in the early postoperative period.It is safe and reliable to perform most gastrectomy for patients with acute gastroduodenal perforation within 24 hours,which can cure ulcers,significantly reduce recurrence and treat complications.