腹腔镜与开腹手术修补上消化道溃疡穿孔临床对比研究  

A retrospective analysis of laparoscope versus open repair on treating upper gastrointestinal ulcer perforation

作　　者：马忠明[1] 严宏立[1] 

机构地区：[1]成都市第一人民医院普外科,610000

出　　处：《中国医师进修杂志》2012年第8期5-7,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的评价胃十二指肠溃疡穿孔修补术中腹腔镜手术是否优于传统开腹手术。方法回顾性分析143例上消化道溃疡穿孔修补术患者，其中腹腔镜组98例，开腹组45例。手术方法包括单纯间断缝合或带蒂大网膜补片填塞缝合修补。术后常规使用质子泵抑制剂、β-内酰胺类抗生素及甲硝唑三联抗溃疡治疗。对比分析两组患者的临床疗效。结果腹腔镜组手术时间明显长于开腹组[（83．88±19．67）min比（63．33±12．06）min]，肛门排气时间、住院时间、住院费用、镇痛剂用量均明显少于开腹组[（29．45±9．24）h比（46．40±49．21）h、（6．92±1．06）d比（7．71±2．48）d、（6929．39±832．40）元比（7546．67±1393．92）元、（5．7±8．3）mg比（10．9±9．5）mg]，两组比较差异有统计学意义（P〈0．01）；两组患者穿孔直径、穿孔部位、腹腔引流量比较差异无统计学意义（P〉0．05）。腹腔镜组并发症发生率为14．29％（14／98），开腹组为26．67％（12／45），两组比较差异无统计学意义（P〉0．05）。结论腹腔镜上消化道溃疡穿孔修补术是一种安全可行而更加经济的手术方法。尽管手术时间较开腹手术长，但并未增加术后并发症发生率。Objective To evaluate the effect of laparoscope and open repair on treating upper gastrointestinal （UGI） ulcer perforation. Methods Retrospective analysis was performed in consecutive series of 143 patients undergoing UGI ulcer perforation repairing. Among the total 143 patients, 98 cases underwent laparoscope repair （laparoscope group）,45 cases were with open repair （open group）. The operation methods included either simple interrupted suture or pedieled omental patch. Postoperative management of triple therapy included proton pump inhibitor, β -lactam antibiotics and arilin was conducted.Therapeutic effects were compared between two groups. Results Operating time in laparoseope group was significantly longer than that in open group [ （83.88 ± 19.67） min vs. （63.33 ± 12.06） min, P 〈 0.01 ]. Time of passage of gas by anus, hospital stay, cost of hospitalization and postoperative dosage of opiates in laparoscope group were significantly lower than those in open group [ （29.45 ± 9.24） h vs. （46.40 ± 49.21 ） h, （6.92 ± 1.06） d vs.（7.71 ± 2.48） d, （6929.39 ± 832.40） yuan vs. （7546.67 ± 1393.92） yuan, （5.7 ± 8.3） mg vs. （ 10.9 ± 9.5） mg,P〈 0.01 ]. There was no significant difference between two groups in perforated diameter, perforated position and flushing dose of abdominal cavity （ P 〉 0.05 ）. The rate of complication was 14.29% （14/98） in laparoscope group,while 26.67% （12/45） in open group,there was no significant difference between two groups （P 〉 0.05）. Conclusions Laparoscope repair of UGI ulcer perforation is a safe and feasible procedure compared with open repair. Although operating time of laparoscope repair is longer than open repair, the rate of complication does not increase.

关 键 词：消化性溃疡穿孔 腹腔镜 回顾性研究 

分 类 号：R656.62[医药卫生—外科学]