腹腔镜胃十二指肠溃疡穿孔修补术与开腹手术的疗效比较

Curative effect comparison of repair of gastroduodenal ulcer perforation with laparoscopy and laparotomy operation

目的：探讨腹腔镜胃十二指肠溃疡穿孔修补术与开腹手术的疗效。方法选取2010年1月~2013年12月浙江省宁波市北仑区人民医院普外科就诊的胃十二指肠溃疡穿孔患者84例。采用随机数字表将84例患者分为腹腔镜组（n=42）与开腹组（n=42），分别采用腹腔镜胃十二指肠溃疡穿孔修补术与开腹胃十二指肠溃疡穿孔修补术。观察并记录两组患者的手术时间、手术出血量、术后下床活动时间、肛门排气时间、镇痛剂使用率、术后住院时间和术后并发症发生率。结果腹腔镜组手术时间、手术出血量、术后下床活动时间、肛门排气时间、镇痛剂使用率和术后住院时间[（54.7±14.2）min、（10.9±1.8）mL、（19.5±5.1）h、（40.7±13.2）h、4.76%、（6.92±1.17）d]均明显少于开腹组[（69.4±18.7）min、（22.8±4.7）mL、（46.3±8.1）h、（58.1±17.3）h、21.43%、（8.43±2.04）d]，差异均有统计学意义（t=2.29、3.19、3.67、2.45，χ2=5.13，t=2.23，P 〈0.05或P 〈0.01）。腹腔镜组和开腹组术后分别发生并发症2例（4.76%）和8例（19.05%），腹腔镜组术后发生并发症的发生率明显低于开腹组（χ2=4.16，P〈0.05）。术后2个月复查胃镜，腹腔镜组和开腹组溃疡愈合分别为38例（90.48%）和36例（85.71%），两组患者溃疡临床愈合率比较差异无统计学意义（χ2=0.46，P〉0.05）。术后随访5~40个月，平均（21.3±4.1）个月，均未见溃疡复发。结论腹腔镜胃十二指肠溃疡穿孔较开腹术具有手术时间短、手术出血量少、术后肛门排气快、术后痛苦轻、住院时间短和术后并发症少等优点，是治疗胃十二指肠溃疡穿孔更佳的术式。

Objective To discuss curative effect of repair of gastroduodenal ulcer perforation with laparoscopy and la-parotomy operation. Methods 84 cases of patients with gastroduodenal ulcer perforation, who were given the medial treatment in General Surgery Department of Beilun District People’s Hospital in Ningbo City from January 2010 to De-cember 2013, were selected and divided into laparoscopy group （n=42） and laparotomy group （n=42） by table of random number, who were given repair of gastroduodenal ulcer perforation with laparoscopy and laparotomy operation respec-tively. The operation time, amount of bleeding in the operation, postoperative out-of-bed activity time, anal exhaust time, rate of use analgesics, length of stay （LOS） and occurrence rate of complication of patients in two groups were ob-served and recorded. Results The operation time, amount of bleeding in the operation, postoperative out-of-bed activity time, anal exhaust time, rate of use analgesics and LOS of patients in laparoscopy group [（54.7±14.2） min, （10.9±1.8） mL, （19.5±5.1） h, （40.7±13.2） h, 4.76%, （6.92±1.17） d] were shorter or less than those in laparotomy group [（69.4±18.7） min, （22.8±4.7） mL, （46.3±8.1） h, （58.1±17.3） h, 21.43%, （8.43±2.04） d] with statistically significant difference （t=2.29, 3.19, 3.67, 2.45, χ2=5.13, t=2.23, P〈 0.05 or P〈 0.01）. 2 cases （4.76%） and 8 cases （19.05%） of complication ap-peared in laparoscopy group and laparotomy group respectively （χ2=4.16, P〈0.05）. According to the reexamination by gastroscope 2 months after the operation, 38 cases （90.48%） and 36 cases （85.71%） of ulcer healing appeared in la-paroscopy group and laparotomy group respectively. After comparing the clinical ulcer healing rates of patients in two groups, there was no statistical differences appeared （χ2=0.46, P〉0.05）. According to the postoperative following-ups between 5 and 40 months, （21.3±4.1） months for average, there was no reoccurrence of ulcer appeared. Conclusion Repair of gastroduodenal ulcer perforation with laparoscopy has short operation time, little amount of bleeding during the operation, short postoperative anal exhaust time, light painful feelings, short LOS, low occurrence rate of complica-tion and etc, which is the favorable medical treatment to treat gastroduodenal ulcer perforation.