腹腔镜与开腹胃十二指肠溃疡穿孔修补的临床对比研究

The Clinical Comparative Study of Laparoscopic versus Open Repair of Perforated Gastroduodenal Ulcer

[摘要]目的探讨腹腔镜修补术治疗胃十二指肠溃疡穿孔的临床效果和优势。方法收集我院2007年3月至2012年12月问用腹腔镜行胃十二指肠溃疡穿孔修补术的28例临床资料，并将其与同期行开腹穿孔修补的32例病例进行回顾性病例对照研究。结果腹腔镜与开腹手术相比，手术时间、切口感染率和腹腔积液感染率差异无统计学意义（P〉0．05）。但腹腔镜术中出血量、术后胃肠功能恢复时间、住院时间、镇痛剂使用率等指标均显著优于开腹组（P〈0．01）。对两组患者进行随访，平均随访时间为15（3—28）个月，经胃镜检查均未见溃疡复发。结论腹腔镜治疗胃十二指肠溃疡穿孔安全有效，具有侵袭性小、腹腔干扰小、术后痛苦小、肠功能恢复快、住院时间短等优点。

Objective To explore the clinical results and advantages of the laparoscopic repair in the treatment of gastroduodenal ulcer perforation. Methods The clinical data was collected in 28 patients re- eieved laparoscopie repair for gastroduodenal ulcer perforation from March 2007 to December 2012 in our hos- pital, and 32 patients performed open repair at the same period were chosen as control groups. The clinical data of the two groups was retrospectively compared in this case control study. Results There was no sig- nificant difference in the operation time, the incision infection rate and the ascites infection rate between the two groups （P〉0.05）, which was （75.1 ＋10.0）min vs. （79.2＋8.5）rain, 0 vs. 9.4% （3/32） and0 vs. 6.2% （2/32）. The blood loss, the stomach intestine functional recovery time, the mean time of hospitali- zation and the postoperative requirement of analgesic was obviously better in laparoscopy group than the con- trol group（P〈0.01）, whiehwas （15.0±5.8）mlvs. （40.2±18.6）ml, （32.1 ±8.3）h vs.（ 62.3 ± 14.3）h, （6.9 ±1.5）d vs. （10.3 ±1.2）d, and 10.7%（3/28）vs. 59.4%（19/32）. All the 60 cases were followed up for averagely 15 （3 ~28） months, and no ulcer relapsed under gastroscope. Conclusion The laparoscopic repair has the advantages of little operation wound, few postoperative complication and short length of hospital stay. It is a safe and efficient minimally invasive method for peptic ulcer perforation.