腹腔镜辅助治疗巨大消化性溃疡穿孔53例

Laparoscopic-assisted surgery for perforated peptic ulcer: Analysis of 53 cases

目的:研究腹腔镜下辅助小切口治疗巨大消化性溃疡穿孔的临床效果,为临床上该类疾病的治疗提供依据.方法:选择2010-02/2013-10于我院入院治疗的巨大消化性溃疡穿孔患者106例,随机分为两组,对照组采用传统的开腹修补术,治疗组采用腹腔镜加辅助小切口修补术,记录并比较两组患者手术时间、出血量、肛门排气时间等围手术期指标,并比较疼痛评分、镇痛药的使用率以及并发症发生率.结果:治疗组患者手术中出血量、术后下床活动时间、肛门排气时间、住院时间以及肠鸣音恢复时间均明显少于对照组,差异有统计学意义(42.0 mL±12.1 mL vs 156.0 mL±34.6mL,10.4 h±2.9 h vs 38.7 h±9.7 h,16.8 h±2.3 h vs 40.6 h±6.9 h,6.6 d±2.1 d vs 12.8 d±3.5 d,18.4 h±5.6 h vs 45.6 h±7.7 h,P<0.05);治疗组患者手术后1、3及7 d的疼痛评分明显低于对照组,镇痛药物的使用率也明显低于对照组,差异有统计学意义(3.1±0.4 vs 5.3±0.3,2.4±0.6 vs 4.4±0.4,1.6±0.2 vs 3.2±0.3,11.3%vs 43.4%,P<0.05);治疗组患者切口感染、炎性肠梗阻等并发症的发生率明显低于对照组,差异有统计学意义(P<0.05).结论:腹腔镜辅助小切口治疗巨大消化性溃疡穿孔的临床效果明显好于传统开腹手术,创伤小,并发症少,患者的痛苦轻,值得临床推广应用.

AIM： To explore the effect of laparoscopic-assisted surgery for perforated peptic ulcer to provide evidence for the clinical treatment of such disease. METHODS： One hundred and six patients with perforated peptic ulcer were enrolled in this study from February 2010 to October 2013 at our hospital. The patients were randomly assigned to receive traditional laparotomy（control group） or laparoscopic-assisted surgery（treatment group）, with 53 patients in each group. The operative time, blood loss, flatus time and other perioperative indicators, as well as pain score, painkiller utilization and complication rate were recorded and compared between the two groups. RESULTS： The treatment group had significantly lower postoperative blood loss, ambulation time,flatus time, hospitalization time and time to recovery of bowel sounds than the control group（42.0 mL ± 12.1 mL vs 156.0 mL ± 34.6 mL, 10.4 h ± 2.9 h vs 38.7 h ± 9.7 h, 16.8 h ± 2.3 h vs 40.6 h ± 6.9 h, 6.6 d ± 2.1 d vs 12.8 d ± 3.5 d, 18.4 h ± 5.6 h vs 45.6 h ± 7.7 h, P 0.05）. The pain scores on postoperative days 1, 2 and 7 were significantly lower in the treatment group than in the control group（3.1 ± 0.4 vs 5.3 ± 0.3, 2.4 ± 0.6 vs 4.4 ± 0.4, 1.6 ± 0.2 vs 3.2 ± 0.3, 11.3% vs 43.4%, P 0.05）. The incidences of wound infection and inflammation were significantly lower in the treatment group than in the control group（P 〈0.05）. CONCLUSION： The effect of laparoscopicassisted surgery is superior to that of traditional laparotomy in the management of perforated peptic ulcer.