腹腔镜胃十二指肠溃疡穿孔修补术13例临床体会

Laparoscopic repair of acute perforation for gastroduodenal ulcer

目的腹腔镜急性胃、十二指肠溃疡穿孔修补术的临床经验。方法2003年6月～2007年12月，对13例急性胃、十二指肠溃疡穿孔患者施行腹腔镜溃疡穿孔修补术。结果13例中十二指肠球部溃疡穿孔5例，幽门管溃疡1例，胃窦部溃疡穿孔7例，穿孔直径为0．3—0．7cm，腹腔内积液600～1200mL。手术时间80～180min，除1例病检胃癌，改开放手术外，其余12例手术均获成功，术后恢复顺利，切口甲级愈合10例，乙级愈合2例。住院天数7—10d。随访1年，胃镜检查溃疡均愈合，无再穿孔、腹腔感染、肠粘连、肠梗阻等并发症发生。结论腹腔镜手术治疗急性胃、十二指肠溃疡穿孔，与开腹手术同样安全且有效。胃溃疡穿孔患者术中需快速病理检查，若为恶性病变应中转开腹。

Objective To summarize the clinical experience of laparoscopic repair of acute perforation for gastroduodenal ulcer. Methods From June 2003 to December 2007, 13 patients underwent laparoscopic repair of perforated peptic ulcers. Results Five patients were suffered from perforated duodenal bulbar ulcer, one patient was suffered from pyloric canal ulcer, and seven patients were suffered from perforated gastric antrum ulcer. The diameter of the perforation was 0. 3-0. 7cm, peritoneal fluid 600-1200ml, the operative time was 80-180min, only one was shifted to open surgery diagnosed gastric cancer by pathology examination, another twelve laparoscopic operations were successful. Postoperative recovery was smooth, ten surgical incisions were class A healing and two were class B healing, the length of hospitalization were 7-10 days after surgery. With one year followed-up, all ulcers had healed well by Gastroscopy, we hadn＇t found reperforation, abdominal infection, ankylenteron, ileac passion ect. operative complications. Conclusions Laparoscopic repair of acute perforated gastroduodenal ulcer is as safe and effective as the open repair. We must do intraoperative rapid pathologic examination, if it was malignant disease we shifted to open surgery