腹腔镜胃十二指肠溃疡穿孔修补的优势和手术体会

doi:j.issn.1009-976X.2015.01.013

摘要/Abstract

摘要： 【摘要】〓目的〓探讨腹腔镜治疗急性上消化道穿孔的临床疗效及优点。方法〓选取2011年1月至2013年12月收治的急性上消化道穿孔确诊患者,年龄26~75岁,平均56.8岁,行腹腔镜修补术43例(腔镜组),开腹修补术40例(开腹组),记录并对比两组的手术时间、寻找病灶时间、术后排气时间、住院时间、术后疼痛评分、并发症等情况。结果〓所有病例均随访6~18个月,平均14.6个月,两组均无围手术期死亡病例和严重并发症;两组的手术时间无明显差异,但在手术中寻找病灶时间、术后排气时间、住院时间、术后疼痛评分和并发症发生率等方面,腹腔镜组明显优于开腹组(P<0.05)。结论〓腹腔镜下行急性上消化道穿孔修补术损伤小、术后恢复快,可成为胃十二指肠穿孔修补手术的首发选择。

关键词: 上消化道穿孔, 腹腔镜, 修补术

Abstract: 【Abstract】〓Objective〓To investigate the efficacy and benefits of laparoscopy in treatment of acute upper gastrointestinal perforation. Methods〓Eighty-three patients with acute upper gastrointestinal perforation were treated from January 2011 to December 2013 in whom 43 cases were treated by laparoscopic surgical repair (laparoscopic group) and 40 cases by open surgery repair (open group).The average age was 56.8 years (26-75years). The operation time, time from operation beginning to find the focus,postoperative exhaust time,hospitalization time,postoperative pain score and complications were recorded and compared between two groups. Results〓All cases were followed up for 6-18 months(average 14.6 months). No death and severe complications in perioperative period occurred in two groups. The time of finding focus, postoperative exhaust time, hospitalization time, postoperative pain score and complications in laparoscopic group were superior to that in control group. Conclusion〓The surgical procedure of laparoscopic surgical repair for treatment of acute upper gastrointestinal perforation has advantage of open operation, and may act as the first choice for acute upper gastrointestinal perforation.

Key words: Upper gastrointestinal perforation, Laparoscopy, Repair

中图分类号:

R656.6

潘平东钟强文常春. 腹腔镜胃十二指肠溃疡穿孔修补的优势和手术体会[J]. 岭南现代临床外科, 2015, 15(01): 56-59.

Pan Pingdong, Zhong Qiangwen, Chang Chun. Advantage of laparoscopic repair in the perforated gastroduodenal ulcer and surgical experience [J]. Lingnan Modern Clinics in Surgery, 2015, 15(01): 56-59.

参考文献

[1] Versaci A, Saladino E, Rossitto M, et al.Intestinal perforation by ingested foregn bodies in the digestive tract: an insidious pathology always of interest[J]. G Chir,2010,31(8-9):379-382.
[2] Straube S, Tramer MR, Moore RA, et al. Mortality with upper gastrointestinal bleeding and perforation:effects of time and NSAID use[J].BMC Gastroenterol,2009,5(9):41.
[3]Lanas A. A review of the gastrointestinal safety data--a gastroenterologist’s perspective[J].Rheumatology (Oxford),2010,49(2):3-10.
[4]王志军，王加一，陈小莉.上消化道穿孔患者死亡的危险因素[J].中国现代医学杂志,2012, 22 (12):76-78.
[5] Mouret P. Laparoscopic treatment of perforated peptic ulcer [J] . Br J Surg, 1990, 77( 9) : 1006.
[6]李公明,刘自立,王建华.腹腔镜治疗消化道穿65例临床观察[J].中国实用医药,2011,6(21):129-130.
[7] Bertleff MJ, Lange JF. Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature[J]. Surg Endosc,2010,24(6):1231-1239.
[8]张炽棠.腹腔镜与开腹手术治疗上消化道穿孔疗效比较[J].中国现代普通外科进展,2012,15(1):62-63.
[9]李启荣，龙仁平.腹腔镜在急性上消化道穿孔治疗中的应用[J]. 微创医学,2012,7(5):524-525
[10]Patel T, Bickenbach K, Semrad C, et al. Laparoscopic ileostomy in severe obscure gastrointestinal hemorrhage: diagnostic laparoscopic ileostomy[J]. Arch Surg,2010,145(8):745-748.
[11] 杨明威, 陈海涛. 三孔法腹腔镜胃十二指肠溃疡穿孔修补术[J]. 广东医学, 2007, 28 (7): 1099-1100.
[12]黄振华，刘维藩，林木平，等.腹腔镜治疗胃、十二指肠溃疡穿孔52例[J]. 广东医学院学报,2012,30(2):190-191.
[13]谢正勇，程黎阳，张玉新，等。快速康复外科在急诊上消化道穿孔修补术中的应用[J].实用医学杂志,2012,28(1):21-24.

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