腹腔镜辅助手术治疗胃十二指肠穿孔的疗效分析

Efficacy of Laparoscopic-assisted Surgery for Gastroduodenal Perforation

目的：分析腹腔镜辅助手术治疗胃十二指肠穿孔的疗效,并与开腹手术对比,为胃十二指肠穿孔最佳术式的选择提供依据。方法：根据术式将本院2011年1月-2013年6月收治的67例胃十二指肠穿孔患者分为开腹组（33例）和腹腔镜组（34例）,分别接受开腹手术和腹腔镜辅助手术治疗胃十二指肠穿孔,分析两组的时间指标（手术、术后排气、胃肠功能恢复及术后住院）和术中出血量,记录两组术后的并发症情况并评价手术效果,术后半年随访调查对进食情况的影响。结果：腹腔镜组的手术时间长于开腹组,术后排气时间、胃肠功能恢复时间及术后住院时间均短于开腹组,术中出血量少于开腹组,差异有统计学意义（P〈0.05）。两组治疗总有效率的差异无统计学意义,但腹腔镜组的痊愈率高于开腹组（P〈0.05）;腹腔镜组术后半年的食欲、食物浓度及每餐进食量均优于开腹组,差异有统计学意义（P〈0.05）。两组术后并发症发生率的差异无统计学意义（P〉0.05）。结论：腹腔镜辅助手术治疗胃十二指肠穿孔的疗效较好,降低术中出血量及术后恢复时间,对术后进食情况影响较小。

Objective： To compare the efficacy of laparoscopic-assisted surgery and laparotomy for gastroduodenal perforation,hoping to provide clinical reference for gastroduodenal perforation.Methods：According to the surgical approach,67 patients treated with gastroduodenal perforation were assigned to receive laparoscopic-assisted surgery（LA group） or laparotomy（L group）.The time-related indicators（surgery,exhaust,recovery of gastrointestinal function and postoperative hospital stay） and intraoperative blood loss were analyzed between groups.The effect of surgery was evaluated and postoperative complications were recorded.The patients were followed up for six months to evaluate eating situations.Results：There were longer operative time and shorter postoperative discharge time,postoperative gastrointestinal function recovery time and hospital stay in LA group versus L group with significant differences（P〈0.05）.Less intraoperative blood loss was observed in LA group versus L group with significant differences（P〈0.05）.No differences were observed between two groups,but the cure rate of LA group was higher than that of L group（P〈0.05）.The LA group＇s appetite,food concentration and volume of was superior to L group with significant differences（P〈0.05）.The incidence of postoperative complications between two groups had not statistical significances（P〈0.05）.Conclusion：Laparoscopic-assisted surgery for gastroduodenal perforation has a better effect,benefit for reducing the intraoperative blood loss and postoperative recovery time with less impact on the situation after eating.