腹腔镜在胃肠穿孔治疗中的应用(附23例报告)

Laparoscopic operations for gastrointestinal perforation: A report of 23 cases

目的：探讨腹腔镜下或腹腔镜辅助胃肠穿孔修补术的疗效。方法：对18例胃、十二指肠穿孔采用腹腔镜下全层缝合，加盖大网膜结扎固定；1例小肠穿孔在腹腔镜下双层缝合；3例小肠穿孔做腹壁小切口（2～3cm），传统手术方法修补或切除病变肠管；1例乙状结肠穿孔行腹腔镜辅助下乙状结肠襻式造瘘。结果：18例胃、十二指肠穿孔及1例小肠穿孔在腹腔镜下完成修补术；3例小肠穿孔及1例乙状结肠穿孔在腹腔镜辅助下完成修复术。手术时间35～80min，平均50min。无并发症发生。23例随访6～24个月，平均18个月，18例胃、十二指肠穿孔术后6～8个月胃镜检查无溃疡复发，无肠梗阻等并发症发生。结论：腹腔镜治疗胃肠穿孔创伤小、恢复快、疗效满意。

Objective To investigate the curative effect of laparoscopic or laparoscopically-assisted repair of gastrointestinal perforation. Methods Eighteen patients with gastroduodenal perforation underwent laparoscopic full-thickness repair with greater omentum covering. One patient with intestinal perforation underwent double-layer suture. Three patients with intestinal perforation were treated with mini-incisional repair or partial enterectomy. One patient with perforation of the sigmoid colon received laparoscopically-assisted loop sigmoidostomy. Results Laparoscopic repair was successfully accomplished in 18 patients , while laparoscopically-assisted repair was carried out in 3 patients with intestinal perforation and 1 patient with perforation of the sigmoid colon. The operation time was 35～80 rain （mean, 50 rain）. No complications occurred. Follow-up observations in 23 patients for 6～ 24 months （mean, 18 months） revealed no recurrence of peptic ulcer in 18 patients with gastroduodenal perforation within 6～ 8 months and no intestinal obstruction. Conclusions Laparoscopic operations for gastrointestinal perforation is micro-invasive and effective.