腹腔镜下Taylor手术治疗十二指肠溃疡穿孔的临床疗效分析  

作　　者：唐岩 罗梦笔 

机构地区：[1]浙江省余姚市第二人民医院,315400

出　　处：《浙江临床医学》2018年第9期1549-1550,共2页Zhejiang Clinical Medical Journal

摘　　要：目的探讨腹腔镜下穿孔修补术并行迷走神经后干切断加胃前壁浆肌层切开缝合术（即腹腔镜TTaylor手术）治疗十二指肠溃疡穿孔的临床疗效。方法回顾分析38例十二指肠溃疡穿孔行腹腔镜TTaylor手术治疗患者的临床资料（观察组），包括手术时间、术后下床时间、住院时间、住院费用、基础胃酸分泌量及术后复发率等，并与同期40例行开放式十二指肠溃疡穿孔单纯修补术患者（对照组）进行比较分析。结果腹腔镜下Taylor手术38例中32例完成手术，6例中转为开腹穿孔修补加Taylor手术。观察组手术时间比对照组显著延长（P〈0．05），观察组下床活动时间、住院时间比对照组明显缩短（P〈0．05），观察组住院费用显著高于对照组（P〈0．05），观察组入院后24h、48h、72h基础胃酸分泌量均比对照组显著降低。观察组术后随访溃疡复发率0％，对照组术后随访溃疡复发率12．5％，差异有统计学意义（P〈0．05）。结论腹腔镜下Taylor术式治疗十二指肠溃疡穿孔，具有恢复较快、疗效确切、溃疡复发率低等明显优势，严格把握适应证后值得临床推广应用。Objective To investigate the clinical efficacy of laparoscopic Taylor operation for perforated duodenal ulcers. Methods 78 patients who were diagnosed as perforated duodenal ulcers and received operations were retrospectively enrolled, with observation group （laparoscopic Taylor operation, 38 cases ） and control group （ open repair operation, 40 cases ） . Intra-operative and postoperative parameters, such as operation time, active time postoperative, hospital stay, hospitalization cost, BAO and the recurrent rate were compared between two groups. Results In observation group, 6 patients had been transferred to open repair plus Taylor operation. As compared to control group, observation group had longer operation time, higher hospitalization cost, while with shorter active time postoperative and hospital stay （ P〈0.05 ） , Level of BAO of observation group at 24h, 48h and 72h after admission were significantly lower than that of control group （ P〈0.05 ） . There was a significant difference on the recurrent rate of ulcers between two groups （ 0% in the observation group vs 12.5% in the control group, P〈0.05 ） . Conclusion Laparoscopic Taylor operation can provide enhanced recovery after surgery, outstanding effect and low ulcer recurrence. It may be preferable for treating perforated duodenal ulcers than open repair operation. It is worthy of clinical application with strict indications.

关 键 词：穿孔性十二指肠溃疡 腹腔镜 Taylor手术 壁细胞迷走神经切断术 

分 类 号：R656.62[医药卫生—外科学]