腹腔镜与开腹手术治疗胃十二指肠穿孔的疗效比较

The efficacy of laparoseopic surgery versus that of open surgical treatment for gastroduodenal perforation

目的探讨腹腔镜与开腹手术治疗胃十二指肠穿孔的临床疗效。方法我院于2008年1月-2011年6月按照随机数字法将72例胃十二指肠穿孔患者随机分为观察组和对照组，两组患者分别采用腹腔镜下和传统开腹行穿孔修补术治疗，并对两组临床疗效进行对比研究。结果在手术过程中及术后对两组患者的各项临床指标进行比较发现，治疗组患者的术中平均出血量仅为（13．4±1．4）ml，明显低于对照组的（48．5±1．7）ml；另外，治疗组患者的术后排气时间和下床活动时间与对照组相比也明显减少，差异有显著性（P〈0．05）。治疗组患者的术后体温异常率仅为7．8％，与对照组（88．0％）相比明显下降，且差异有显著性（P〈0．05）。结论腹腔镜下胃十二指肠穿孔修补术较传统开腹修补术具有损伤小、痛苦轻、腹腔干扰小、胃肠功能恢复快、术后并发症少等优点，有临床推广应用价值。

Objective To explore the efficacy of laparoscopic surgery and open surgical treatment for gastroduodeual perforation. Methods 72 patients with gastroduodenal perforation who had been hospitalized during the period of January 2008 to June 2011 were randomly assigned to receive endoscopic repair （ study group ） or conventional open surgical repair （ control group ）. The efficacy of the two groups were compared. Results Clinical indexes were compared intraoperatively and postoperatively between the two groups. The mean intraoperative blood loss was significantly less in the study group than in the control group （ [13.4 ± 1.d] ml vs. 48.5± 1.7 ）]. In addition, time to postoperative flatus and that to ambulation were markedly shorter in the study group than in the control group, the difference being statistically significant （ P 〈 0.05 ）. Rate of abnormal postoperative body temperature was significantly lower in the study group than in the control group （ 7.8% vs. 88.0% ）, the difference being statistically significant （ P 〈 0.05 ）. Conclusions Patients undergoing laparoscopic repair have smaller incision, less pain, slighter abdominal interruption, quicker recovery of gastrointestinal function, and fewer postoperative complications than those receiving conventional open surgical repair. The former procedure is worth popularizing clinically.