Long-term curative effects of suture plus proximal gastric vagotomy or triad-therapy for duodenal ulcer with acute perforation / 中华外科杂志

<p><b>OBJECTIVE</b>To study the long-term curative effects of suture plus proximal gastric vagotomy (PGV) and suture plus triad-therapy (omeprazole, amoxycillin and flagyl taken orally) for the treatment of duodenal ulcer with acute perforation.</p><p><b>METHODS</b>Three hundred and twenty-nine patients with duodenal ulcer and acute perforation were treated with 2 different methods, respectively. Method A was suture plus PGV (group A, 153 cases), and method B was suture plus triad-therapy (group B, 176 cases). Follow-up was made by means of correspondence, outpatient reexamination and cooperation with local hospitals in 5 to 8 years after operation. The contents of follow-up included symptom acquisition (such as upper abdominal pain or distention, pyrosis, belch, acid regurgitation, vomiting, diarrhea and conditions of living or working), gastroscopy and Helicobacter pylori (HP) detection. The curative effects were evaluated by the Visick scale.</p><p><b>RESULTS</b>Three hundred and one patients were followed up (group A 142 and group B 159). According to the Visick scale, 97 (68.3%), 19 (13.4%), 13 (9.15%) and 13 (9.15%) patients in group A, and 31 (19.5%), 28 (17.6%), 24 (15.1%) and 76 (47.8%) in group B were classified as Visick I, II, III and IV respectively (Z = -9.818, P < 0.01). As for HP detection, there were 130 (91.5%) patients in group A and 94 (59.1%) in group B (chi(2) = 41.438, P < 0.01).</p><p><b>CONCLUSIONS</b>The long-term curative effects of suture plus PGV were superior to those of suture plus triad-therapy for duodenal ulcer with acute perforation although HP positive rate was higher in group A than in group B. HP infection is one of the etiological factors of duodenal ulcer. The increased excitability of the vagus nerve remains to play an important role in duodenal ulcer.</p>

Comprehensive Surgical Therapy for Traumatic Hepatic Break / 中国医师杂志

Objective To raise level of surgical therapy for patients with traumatic hepatic break.Methods We retrospective analyzed 210 cases of traumatic hepatic break at admission from Sep 1987 to Jan 2001.Result Among 198 patients comprehensive operation,182 were cured, the cure rate was 92%.12 patients were all cured by conservative treatment.Severe shock and the main reasons of death were severe traumatic complications.Conclusions Comprehensive operation can greatly improve the succesful rate and reduce the complication,strictly grasping the indication of conservative treatment can greatly improve the cure rate,we consider that the debridement plus packing with the big omentam,selective ligation of hepatic artery and debriding hepatectomy are mainly procedures for the treatment of the patients with tramatic hepatic rupture.

Conservative Therapy Compared with Operations in Early Severe Acute Pancreatitis / 中国医师杂志

Objective To explore indications of the conservative therapy an early operative treatment for severe acute pancreatitis and researching comprehensive therapeutic rule.Methods Retrospective analyze the clinical feature and the result as making a diagnosis and giving treatment of 82 cases of SAP admitted from Aug.1986 to dec.2000.Results Among them,28 cases underwent conservative treatment,with the cure rate of 85.7%,54 cases underwent conservative treatment,with the cure rate of 81.5%,the total cure rate was 82.9%.Conclusions The conservative therapy or early operation of SAP is determined by the patients' clinica feature,while the supportive conservative therapy being on,we should carefully observe the changes of the patient's condition and the response to therapy,when once surgical indication being discovered,early operation should be performed ,the emergency surgery should be performed as soon as possible for the biliary obstruction of SAP.