倒刺缝线修补胃十二指肠溃疡穿孔的临床观察

doi:10.3969/j.issn.1009-976X.2021.04.010

摘要/Abstract

摘要： 目的探讨倒刺缝线在腹腔镜胃十二指肠溃疡急性穿孔中的应用效果。方法 80例行腹腔镜胃十二指肠溃疡穿孔修补术患者分为2组,每组各40例,观察组术中使用倒刺线缝合,对照组使用普通微乔线缝合。比较两组患者缝合时间、手术时间、肛门恢复排气时间及住院时间,并发症的发生率。结果观察组缝合时间（6.64±1.15）min,对照组缝合时间为（9.53±1.28）min,观察组短于对照组（P<0.05）,观察组手术时间为（37.15±3.49）min,而对照组为（42.40±3.34）min,观察组短于对照组（P<0.05）。观察组、对照组肛门恢复排气时间分别为（39.58±4.78）h、（40.66±4.25）h,两组差异无统计学意义（P>0.05）。观察组对照组住院时间分别为（8.08±0.92）d、（8.35±0.98）d,两组差异无统计学意义（P>0.05）。观察组术后4例并发肺部感染,对照组为6例,两组差异无统计学意义（P>0.05）。结论腹腔镜胃十二指肠穿孔修补术中使用倒刺缝线能够缩短缝合时间和手术时间,是一种可行的技术。

关键词: 腹腔镜, 消化性溃疡穿孔修补术, 倒刺缝线, 临床效果

Abstract: Objective To study the clinical effect of barbed suture in laparoscopic repair of perforation of gastroduodenal ulcer. Methods Eighty patients undergoing laparoscopic repair of gastroduodenal ulcer perforation were divided into two groups with forty patients in each group. The observation group was sutured with barbed wire in management of gastroduodenal perforationduring operation, while the control group was sutured with ordinary Microjoe wire. To compare the suture time, operation time, anal recovery time,in hospital time and Incidence of complications in two groups. Results The suture time and operative time of the observation group were （6.64±1.15）min and （37.15±3.49）min, and that of the control group were （9.53±1.28）min and （42.40±3.34）min, which were shorter than that of the control group （P<0.05）. The anal recovery time and in hospital time of the observation group were （39.58±4.78）h and （8.08±0.92）d, and that of the control group were （40.66±4.25）h and （8.35±0.98）d, there were no significant difference between the two groups （P>0.05）. Postoperative pulmonary infection occurred in 4 cases in the observation group and 5 cases in the control group, and the difference between the two groups was not statistically significant （P>0.05）. Conclusion The use of barbs in laparoscopic gastroduodenal perforation repair can shorten the suture time and operation time, is a feasible technology.

Key words: laparoscope, repair of peptic ulcer perforation, barbedsuture, clinical effect

中图分类号:

R656.6

黄锋明, 张炎彬, 王树钦. 倒刺缝线修补胃十二指肠溃疡穿孔的临床观察[J]. 岭南现代临床外科, 2021, 21(04): 425-427.

HUANG Feng-ming, ZHANG Yan-bin, WANG Shu-qin. Clinical effect of barbed suture in laparoscopic repair of perforation of gastroduodenal ulcer[J]. Lingnan Modern Clinics In Surgery, 2021, 21(04): 425-427.

参考文献

[1] 李连博,张利兵,闫焕,杨正兵. 腹腔镜下倒刺缝线与可吸收缝线行十二指肠菱形吻合的效果比较[J]. 中国内镜杂志, 2019, 25(5): 37-40.
[2] 郑逸锋,李威,王怀明. 单向倒刺缝线在腹腔镜胃十二指肠巨大溃疡穿孔修补术的使用经验[J]. 岭南现代临床外科, 2018, 18(1): 49-51, 56.
[3] Sanabria A, Villegas MI, Morales Uribe CH. Laparoscopic repair for perforated peptic ulcer disease [J]. Cochrane Database Syst Rev, 2013, (2): CD004778.
[4] Quah GS, Eslick GD, Cox MR.Laparoscopic repair for perforated peptic ulcer disease has better outcomes than open repair[J]. J Gastrointest Surg, 2019, 23(3): 618-625.
[5] Katkhouda N, Mavor E, Mason RJ, et al.Laparoscopic repair of perforated duodenal ulcers: outcome and efficacy in 30 consecutive patients[J]. Arch Surg, 1999, 134(8): 845-850.
[6] Siu WT, Leong HT, Li MK.Single stitch laparoscopic omental patch repair of perforated peptic ulcer. J R Coll Surg Edinb, 1997, 42(2): 92-94.
[7] Alemrajabi M, Safari S, Tizmaghz A, et al.Laparoscopic Repair of Perforated Peptic Ulcer: Outcome and Associated Morbidity and Mortality[J]. Electron Physician, 2016, 8(6): 2543-1545.
[8] 马云涛,苏河,王晓鹏,等. 腹腔镜下修补急性胃十二指肠溃疡穿孔的治疗体会[J]. 中国内镜杂志, 2007, 13(11): 1186-1188.
[9] Ruff GL.The history of barbed sutures[J]. Aesthet Surg J, 2013, 33(3 Suppl): 12S-16S.
[10] 何攀,赖莉,苏松,等. 单向倒刺线与传统缝线在腹腔镜胆总管一期缝合术中应用比较的Meta分析[J]. 中国普通外科杂志, 2019,28(2):142-152.
[11] 曲发军,张向民,叶剑青,等. 倒刺缝合线联合“2 + 1”缝合技术在腹腔镜肾部分切除术中的应用体会[J]. 腹腔镜外科杂志,2018,23(2):123-126.
[12] Rosen AD.New and emerging uses of barbed suture technology in plastic surgery[J]. Aesthet Surg J, 2013, 33(3 Suppl):90S-95S.
[13] Iavazzo C, Mamais I, Gkegkes ID.The role of knotless barbed suture in gynecologic surgery: systematic review and meta-analysis[J]. Surg Innov, 2015, 22(5): 528-539.

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