上消化道穿孔的腹腔镜处理及肝圆韧带在穿孔修补术中的应用

Laparoscopic treatment of upper gastrointestinal perforation and the use of ligamentum teres hepatis for perforation repair

目的：探讨腹腔镜上消化道穿孔修补术的临床价值及特殊情况下肝圆韧带在穿孔修补术中的应用价值。方法：回顾分析2009年6月至2013年6月为50例上消化道穿孔患者行腹腔镜手术的临床资料，其中单纯缝合术23例，网膜修补术15例．带蒂肝圆韧带修补术12例。结果：48例顺利完成腹腔镜手术，1例因病程超过3d粘连严重、1例因胃后壁穿孔而中转开腹；手术时间单纯缝合术平均（39±8）min，附加网膜修补术平均（55±11）min，带蒂肝圆韧带修补术平均（65±13）min；术后住院5～8d，平均（5．5±0．8）d。术后均无瘘、幽门狭窄梗阻、肠梗阻、腹腔脓肿、副损伤等并发症发生，未遗漏病灶。结论：腹腔镜修补上消化道穿孔安全、可靠、微创、美观，肝圆韧带具备解剖学优势，特殊情况下，用于修补胃十二指肠穿孔是理想的替代方法。

Objective ： To explore the clinical value of laparoscopic upper gastrointestinal perforation repair and the use of liga- mentum teres hepatis for repair in special circumstances. Methods：The clinical data of 50 patients with upper gastrointestinal perfora- tion who underwent laparoscopic treatment from ]un. 2009 to Jun. 2013 were retrospectively analyzed. Among them ,23 cases underwent simple suture, 15 cases received repair with omentum,and 12 cases underwent repair with pedicle ligamentum teres hepatis. Results：In the 50 patients,48 laparoseopie operations were successfully completed, 1 patient with severe adhesion due to long course of disease （ more than three days） , another case due to perforation on the stomach posterior wall, were converted to laparotomy. The average opm＇a- tion time was （39 ＋-8） rain for simple suture, （55 -＋ 11 ） min for additional omentum repair,and （65 ＋- 13） rain for pedicle ligamentum teres hepatis repair. Postoperative hospital stay was 5-8 d with the average of （ 5.5 -＋ 0.8） d. There were no fistula, py｜oric stenosis and obstruction,ileus, abdominal abscess,concurrent damage or other complications, and no missing tumors. Conclusions ： Laparoseopie re- pair of upper gastrointestinal perforation is safe, reliable, minimally invasive and cosmetic. The ligamentum teres hepatis owns anatomical advantage,in some special cases,it is an ideal alternative patch for the repair of gastroduodenal perforation.