腹腔镜与开腹手术治疗胃溃疡性穿孔的综合疗效对比

Comparative efficacy of laparoscopic and open surgical treatment for gastric ulcer perforation

目的对比腹腔镜与开腹手术治疗胃溃疡性穿孔的综合疗效。方法选择2011年1月-2013年6月在新疆喀什地区第二人民医院普外科住院治疗的胃溃疡穿孔患者46例,其中行腹腔镜胃穿孔修补术19例(腹腔镜组),开腹胃穿孔修补术27例(开腹组)。对两组术中出血量、手术时间、住院时间进行比较,采用VAS评分比较两组术后1、3、7d疼痛程度,用放射免疫法测定血清胃泌素(GAS)含量,记录两组肠鸣音恢复时间和肛门排气时间。结果开腹组手术时间短于腹腔镜组,腹腔镜组出血量较开腹组少,住院时间短于开腹组,差异有统计学意义(P<0.05),两组术后1h时GAS水平差异无统计学意义,术后24、48h时,腹腔镜组GAS水平高于开腹组,腹腔镜组患者术后肠鸣音恢复时间、肛门排气时间均短于开腹组。腹腔镜组术后第1、3及7天VAS评分低于开腹组,差异有统计学意义(P<0.05)。腔镜组术后有2例(10.5%)使用镇静剂,开腹组术后有15例(55.6%)使用镇静剂,腹腔镜组术后镇静剂使用率低于开腹组,差异有统计学意义(χ2=9.706,P=0.002)。结论腹腔镜手术治疗胃穿孔具有微创的特点,其切口小,术后疼痛轻,患者住院时间短,出血量少。同时腹腔镜还能较快地恢复胃肠动力,是治疗胃溃疡穿孔的有效术式。

Objective To compare the comprehensive efficacy of laparoscopic and open surgical treatment for gastric ulcer perforation. Methods From January 2009 to June 2013, there were 46 patients with gas- tric ulcer perforation, including 19 cases with laparoscopic gastric perforation repair （the laparoscopic group） and 27 cases with open surgical treatment （the laparotomy group）. The blood loss, operative time, hospital stay, VAS scores of the two groups were compared. The serum gastrin （GAS） content was tested by radioimmunoassay. Bowel sounds and flatus recovery time were recorded. Results The operation time in laparotomy group was shorter than laparoscopic surgery group, which had less bleeding and shorter hos- pital stay. The difference was statistically significant （P d0.05）. The levels of GAS in two groups were not statistically significant at 1 h postoperative. After 24, 48 h GAS level in the laparoscopic group was higher than the laparotomy group; the postoperative recovery time of bowel sounds and the flatus time in the laparoscopic group was earlier than that in the laparotomy group. After 1, 3 and 7 d VAS scores were lower than the laparotomy group. The difference was statistically significant （P 〈0.05）. There were two cases （10.5%） and 15 cases using sedatives in laparoscopic and laparotomy surgery group respectively. The difference was statistically significant （;（2 =9. 706, P =0. 002）. Conclusion Laparoscopic gastric sur gery minimally had invasive characteristics of small incision, postoperative pain, shorter hospital stay and less blood loss. Meantime this method can quickly restore gastrointestinal motility, which is an effective surgical treatment for gastric ulcer perforation.