腹腔镜技术在上消化道穿孔中的应用

The applications of laparoscopy in upper gastrointestinal perforation

目的:探讨腹腔镜技术在上消化道穿孔治疗中的应用价值。方法:选择2012年2月至2013年10月收治的46例行急诊手术治疗的上消化道穿孔患者,随机分为腹腔镜手术组与传统开腹手术组,每组23例。对比分析两组手术时间、切口长度、术中出血量、术后72 h引流情况、术后疼痛评分(Prince-Henry评分法)、体温恢复正常时间、首次下床时间、首次排气时间、住院时间、住院费用、并发症等指标。结果:与传统剖腹探查组相比,腹腔镜组手术切口短,术中出血少,术后胃肠功能恢复较快,住院时间短,并发症发生率低,手术费用两组差异无统计学意义。结论:腹腔镜手术治疗消化道穿孔具有明显优势,经验丰富的术者既可明确诊断,又可同时进行治疗,最大程度地减少了患者的创伤,是安全、可行的。

Objective：To discuss the application of laparoscopic technique in the treatment of upper gastrointestinal perforation. Methods：Forty-six patients with upper gastrointestinal perforation,who received emergency operation in the department of general surgery of Chinese PLA General Hospital and Haikou City People＇s Hospital from Feb. 2012 to Oct. 2013,were randomly divided into laparoscopic operation group and traditional operation group（n = 23）. Statistical analysis was made on the following data：the operating time,length of the incision,blood loss,postoperative drainage of 72 h,Prince-Henry score,the time of body temperature returned to normal,first ambulation time,first time of exhaust,hospital stay,the cost of hospitalization,and complication. Results：Compared with traditional operation group,the laparoscopic operation group showed the shorter length of the incision,less blood loss,faster recovery of gastrointestinal function after surgery,shorter hospital stay,lower complication rate,and the cost of surgery had no significantly statistical difference. Conclusions：Laparoscopic operation is a safe and feasible operation with obvious advantages for upper gastrointestinal perforation patients,and experienced surgeons can confirm the diagnosis and treat perforation in the same time,decrease the trauma of patients as much as possible.