腹腔镜下穿孔修补术联合高选择迷走神经切断术治疗十二指肠溃疡穿孔

Laparoscopic Repair Combined with Highly Selective Vagotomy for Perforated Duodenal Ulcer: A Report of 15 Cases

目的探讨腹腔镜下穿孔修补术联合高选择迷走神经切断术治疗十二指肠溃疡穿孔的近期疗效。方法腹腔镜下修补溃疡穿孔,电刀游离迷走神经并进行高选择性切断。结果15例手术成功,无中转开腹手术,手术时间80-120 min,平均100 min;术中出血量150-300 ml,平均225 ml。15例术后随访12-36个月,平均29个月,13例术后1年复查胃镜溃疡消失,1例术后2年出现幽门梗阻保守治疗后好转出院,1例术后3年溃疡复发,经口服药物治疗易控制。结论腹腔镜下穿孔修补术联合高选择迷走神经切断术治疗十二指肠溃疡穿孔具有创伤小,恢复快,效果肯定等优点。

Objective To evaluate the short-term efficacy of laparoscopic repair combined with high selective vagotomy for perforated duodenal ulcer. Methods Repair of perforated duodenal ulcer combined with highly selective vagotomy using electrocautery were performed under laparoscope. Results All the operations were successful without converting to open surgery. The mean of operation time was 100 minutes（ range, 80 - 120 minutes）, and the mean of blood loss was 225 ml（ range, 150 -300 ml）. Gastroscopy showed that duodenal ulcers disappeared in 13 cases 1 year after operation. Pyloric obstruction occurred in 1 case in 2 years after operation, and the symptoms were relieved after conservative treatment. Peptic ulcer relapsed in 1 case 3 years after operation and was controlled by oral administration. Conclusions Laparoscopic repair combined with highly selective vagotomy for perforated duodenal ulcer has the advantages of minimal invasion, quicker recovery and definite efficacy.