消化性溃疡急性穿孔治疗方式的选择(附78例报告)  

The Choice of the Treatment of the Acute Perforation of the Peptic Ulcer( 78 Cases Report)

作　　者：邓炜琳 

机构地区：[1]湖南省攸县人民医院普外科,攸县412300

出　　处：《中国现代手术学杂志》2015年第1期17-20,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨消化性溃疡急性穿孔时分别采用非手术治疗、腹腔镜下修补术、传统开腹手术等3种治疗方法的疗效。方法回顾性分析我院2010年3月-2013年3月期间收治的78例消化性溃疡急性穿孔的临床资料,其中非手术治疗14例,腹腔镜下穿孔修补术30例,开腹手术34例,比较各种治疗方法的疗效。结果 78例患者全部治愈出院,无一例死亡。其中非手术治疗14例,1例中转手术,1例出现腹腔脓肿,经穿刺引流后治愈,1例半年后出现粘连性肠梗阻,保守治疗后治愈。腹腔镜下穿孔修补术中转开腹2例,余均获得成功。腹腔镜组和开腹手术组比较,手术时间明显增加,术中出血量明显减少（P〈0.01）;腹腔镜组和其他两组比较,并发症发生率明显降低（P〈0.05）,住院时间明显缩短（P〈0.01）;但3组在镇痛药使用率、肛门排气时间和复发率比较上无统计学差异（P〉0.05）。结论腹腔镜下穿孔修补术治疗消化性溃疡急性穿孔具有创伤小、操作简单方便、术后恢复快、并发症少等优势,应大力推广;非手术治疗和传统胃大部切除术只要合理掌握适应证,是对其有益的补充。Objective To explore the clinical effects of the laparoscopy,laparotomy and nonoperative therapy for the treatment of the acute perforation of the peptic ulcer patients. Methods Retrospective analysis was carried out in 78 cases treated in our hospital from March 2010 to March 2013. There were 14 cases treated with nonoperative therapy,30 cases with laparoscopy and 34 cases with open surgery. Results All the 78 cases were cured without mortality. In the nonoperative group,there was one patient conversed to laparotomy,and one suffered from the abdominal abscess followed by adhesive intestinal obstruction,which was cured by expectant treatment. In the laparoscopic group,there were 2 cases conversed to laparotomy. Comparing with the open surgery group,the operation time increased significantly and intraoperative bleeding reduced in the laparoscopic group（ P〈0. 01）. Comparing with the other two groups,the complication rate decreased significantly（ P〈0. 05）,and the hospitalization time shortened significantly（ P〈0. 01） in the laparoscopic group. There was no difference of the analgesic use rate and the recovery of enteric function（ P 〉0. 05）.Conclusions It shows significant advantages of the laparoscopic surgery for the treatment of the acute perforation of the peptic ulcer,which is mini-trauma,simple manipulation,quick recovery,and few complication.And the laparotomy and nonoperative therapy are both the supplements with reasonable indications.

关 键 词：消化性溃疡穿孔 腹腔镜检查 剖腹术 非手术疗法 

分 类 号：R656[医药卫生—外科学]