腹腔镜胃高位溃疡穿孔修补术11例报告  

Report of 11 Cases of Laparoscopic Repair for High Gastric Ulcer Perforation

作　　者：何瑞龙 严江[2] 黄坚雄 李永峰 周锋 赵晓智 

机构地区：[1]陕西省宝鸡市高新人民医院普外科,宝鸡721000 [2]汕头大学医学院附属第一医院普外科,汕头515041 [3]汕头潮南民生医院普外二科,汕头515144

出　　处：《中国微创外科杂志》2016年第8期763-765,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜胃高位溃疡穿孔修补术的安全性、可行性。方法 2009年12月-2014年12月行腹腔镜胃高位溃疡穿孔修补术11例,四孔法。将左肝叶推向前上方,暴露胃底部,找到溃疡穿孔,于溃疡穿孔边缘切取组织活检。3-0薇乔线全层交叉缝合（穿孔〈1 cm）或全层间断缝合（穿孔〉1 cm）。在缝合处喷洒康派特医用胶（α-氰基丙烯酸正丁酯）,再以邻近大网膜覆盖,以未剪断的穿孔缝合线结扎固定。结果术中均行溃疡穿孔部组织活检,其中10例单纯溃疡,1例胃底癌,均行胃穿孔修补术。术后均未发生胃漏、感染、出血等并发症。术后3个月10例行胃镜检查证实胃底溃疡愈合,随访6个月-5年,（3.8±1.2）年,均健在;1例胃底癌未再复诊。结论只要术中妥善暴露,及时发现,操作恰当,腹腔镜胃高位溃疡穿孔修补术是一种安全有效、简便可行的术式。Objective To evaluate the safety and feasibility of laparoscopic repair for high gastric ulcer perforation（ LRHGUP）. Methods Clinical data of 11 cases of LRHGUP from December 2009 to December 2014 were retrospectively analyzed. The surgery was conducted with the 4-port method. The left liver lobe was pushed anteriorly and superiorly to expose the gastric fundus to locate the lesion. Histological biopsy was carried out at the margin area of the ulcer perforation. The lesions were treated with whole layer cross suture（ lesion〈1 cm） or whole layer interrupted suture（ lesion〉 1 cm）. Medical glue（ α-butylcyanoacrylate） was sprayed on the suture. The greater omentum was used to cover the lesion,which was fixed with suture threads. Results There were 10 cases of simple ulcer and 1 case of gastric fundus carcinoma. No gastric fistula,infection or bleeding occurred after operation. Gastroscopy examination 3 months after operation confirmed ulcer healing in the 10 cases. Followups for 0. 5- 5 years [mean,（ 3. 8 ± 1. 2） years] showed all patients survived. The other one case of gastric carcinoma was not visited. Conclusion LRHGUP is effective,safe,simple and practicable,as long as good intraoperative exposure,timely detection and proper operation performance.

关 键 词：胃高位溃疡穿孔 腹腔镜修补术 

分 类 号：R656.6[医药卫生—外科学]