腹腔镜与开腹消化性溃疡穿孔带蒂网膜修补术临床疗效比较  

Comparing the clinical efficacy between laparoscopic and open omental patch repair for perforated peptic nicer

作　　者：颜松龄[1] 张道建[1] 纪程宏[1] 王东明[1] 郭久冰[1] 

机构地区：[1]厦门市第二医院普外科,361000

出　　处：《中国医师进修杂志》2010年第8期7-9,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的比较腹腔镜与开腹消化性溃疡穿孔带蒂网膜修补术的临床疗效。方法回顾性分析消化性溃疡穿孔带蒂网膜修补术127例，分为腹腔镜组74例，开腹组53例。比较两组的手术时间，术中出血量，术后1、3d疼痛程度，肛门排气时间，恢复饮食时间，腹腔引流管留置时间，手术部位感染，全身并发症及术后住院时间等指标。结果腹腔镜组术中出血量、术后3d视觉模拟评分法（VAS）评分、肛门排气时间、恢复饮食时间、腹腔引流管留置时间、切口感染率、术后住院时间分别为（32．7±25．6）ml、（2．8±1．5）分、（25．8±20．1）h、（2．7±2．1）d、（2．0±1．5）d、0、（4．8±2．3）d，与开腹组的（53．2±30．0）ml、（3．7±2．0）分、（36．9±27．9）h、（3．6±2．3）d、（2．9±2．2）d、9．4％（5／53）、（6．6±4．0）d比较差异有统计学意义（P〈0．01或〈0．05）；两组手术时间、术后1dVAS评分、腹腔内脓肿及全身并发症发生率比较差异无统计学意义。两组术后均无消化道漏、二次手术及死亡病例。结论腹腔镜消化性溃疡穿孔带蒂网膜修补术是安全、有效的，与开腹手术相比具有疼痛轻、肠道功能恢复快、切口感染率低、住院时间短等优势。Objective To investigate the clinical efficacy of laparoscopic versus open omental patch repair for perforated peptic ulcer. Methods One hundred and twenty-seven patients who underwent omental patch repair for perforated peptic ulcer were analyzed retrospectively. There were 74 eases in the laparoscopic repair group （LR group） and 53 cases in the open repair group （OR group） respectively. Operative time, intraoperative blood loss, postoperative pain at 1 d and 3 d, time to first flatus and resumption of diet, time to drainage removal,surgical site infections （wound infection and intra-abdominal abscess）,systemic complications and length of postoperative hospital stay were compared. Results LR group experienced less intraoperative blood loss[ （32.7 ± 25.6） ml ],lower postoperative pain at 3 d[ （2.8 ± 1.5 ） scores ], earlier time to first flatus [ （25.8 ± 20.1 ） hi and resumption of diet [ （2.7 ± 2.1 ） d], shorter time to drainage removal [ （2.0 ± 1.5 ） d ], less wound infection （0） and shorter hospital stay [ （4.8 ± 2.3 ） d ] than those in OR group [ （53.2 ± 30.0） ml, （36.9 ± 27.9 ） h, （ 3.7 ± 2.0） scores, （3.6 ± 2.3 ） d, （2.9 ± 2.2 ） d, 9.4% （5/53）, （6.6 ± 4.0） d ] （P 〈 0.01 or 〈 0,05 ）. There were no significant differences in operative time, postoperative pain at 1 d,incidence of intra-abdominal abscess and systemic complications between the two groups. There were no suture-site leakage, reoperation and death in two groups. Conclusions Laparoscopic omental patch repair for perforated peptic ulcer is safe and efficacious. It has significant advantages over open approach with respects of tess postoperative pain, earlier return of bowel function, less wound infection and shorter hospital stay.

关 键 词：消化性溃疡穿孔 剖腹术 腹腔镜检查 带蒂网膜修补术 

分 类 号：R656[医药卫生—外科学]