改进腔镜Taylor术式治疗十二指肠球部溃疡穿孔的应用价值

Clinical application value of modified laparoscopic Taylor procedure in treatment of perforated duodenal ulcer

目的 探讨改进的腔镜Taylor术治疗十二指肠球部溃疡穿孔的价值.方法 对44例球部溃疡急性穿孔患者采用随机分组原则,改进的腔镜Taylor术为观察组,常规腔镜Taylor术为对照组,每组22例,比较两组手术平均时间、住院平均时间、visick分级疗效、术后基础胃酸（BAO）平均值.结果 观察组手术和住院平均时间短于对照组,差异有统计学意义（P＜0.05）,两组术前BAO平均值比较差异无统计学意义（P＞0.05）,术后BAO平均值比较差异有统计学意义（P＜0.05）.visick分级评价观察组优良率95.46％,对照组86.36％;术后随访1～2年,观察组无溃疡复发,对照组1例复发.结论 改良的腔镜Taylor术不横跨切开贲门下胃底前壁浆肌层,保留了贲门胃底功能的连续性,切断了前干的贲门支下行的神经纤维和“鸦爪”向胃体的折返支,降酸效果良好,术后无溃疡复发,有较好的应用价值.

Objective To explore the clinical value of the improved laparoscopie Taylor operation in treatment for perforated duodenal ulcer. Methods 44 cases were randomly divided into two groups, observation group undergoing improved laparoscopie Taylor Operation, and control group receiving regular Taylor Operation, 22 cases in each group. The average operation time, the average hospitalization time, the curative effect and the average basal gastric acid （BAO） secretion were compared. The effect was evaluated according to Visick classification standard. Results The operation and hospitalization average time of the observation group were significantly shorter than those of the control group （ P 〈 0. 05 ）. There was no significant difference （P 〉 0. 05 ） in the BAO before operation, while there was significant significance （P 〈 0.05） in the BAO after operation. The excellent rate of the observation group evaluated by Visick grading standard was 95.46%, while that of the control group was 86.36%. During a follow-up of 1 to 2 years after operation, there was no recurrence of ulcer in observation group, there was I case of recurrence of ulcer in the control group. Conclusions The modified laparoscopic Taylor Operation preserves the continuity of gastric cardia and fundus function without cutting off the sero-muscular layer of gastric fundus, and reduces gastric acid output by the neurotomy of cardia downward branch of anterior vagal trunk and the gastric body turn-back branch of the emw＇s foot. Worthy of clinical application.