腹腔镜技术在消化道穿孔早期诊断和治疗中的应用体会

Experience of Laparoscopic Technology in the Early Diagnosis and Treatment of Digestive Tract Perforation

目的总结腹腔镜技术诊治急性消化道穿孔的临床经验。方法回顾性分析2009年1月~2013年1月122例术前考虑急性消化道穿孔施行腹腔镜手术的临床资料,其中术前95例明确诊断为消化道穿孔,27例考虑急性消化道穿孔行腹腔镜探查。结果胃溃疡穿孔72例,十二指肠球部溃疡穿孔38例,胆囊穿孔3例,腹内疝2例,小肠穿孔3例,横结肠恶性肿瘤穿孔1例,乙状结肠自发性穿孔1例,阑尾穿孔2例;穿孔直径0.3~1.3 cm,平均0.6 cm。手术均获成功,无任何手术并发症。术后患者疼痛轻微,均未使用止痛剂。切口均甲级愈合。术后住院5~9 d,平均6.5 d。110术后随访3~18个月,平均16个月,无穿孔复发、肠梗阻等并发症。结论腹腔镜手术治疗胃十二指肠溃疡穿孔安全可靠,对于难以明确诊断的消化性溃疡穿孔,可以早期进行腹腔探查,对不同疾病进行镜下手术治疗。

Objective To summarize the clinical experience of laparoscopic technique in the diagnosis and treatment of acute perforation of digestive tract . Methods A retrospective analysis was made on 122 cases of acute gastrointestinal perforation treated by laparoscopic surgery in our hospital from January 2009 to January 2013, 95 of which were definitely diagnosed as digestive tract perforation before surgery and 27 of which were suspected as acute gastrointestinal perforation for laparoscopic exploration . Results There were 72 cases of gastric ulcer perforation , 38 cases of duodenal ulcer perforation , 3 cases of gallbladder perforation , 2 cases of intra-abdominal hernia , 3 cases of small bowel perforation , 1 case of malignant neoplasm perforation of transverse colon , 1 case of spontaneous perforation of sigmoid colon , and 2 cases of appendiceal perforation .The perforation diameter was 0.3-1.3 cm （ mean, 0.6 cm）.All the operations were successful without complications .Mild postoperative pain was noted in patients without use of analgesics.Postoperative hospital stay was 5-9 days （mean, 6.5 days）.Follow-up observations in 110 patients for 3-18 months （mean, 16 months） showed no recurrence and complications such as perforation or bowel obstruction . Conclusion Laparoscopic surgery in the treatment of perforated gastric or duodenal ulcer is safe and reliable .For unconfirmed perforation of digestive tract , early abdominal exploration is applicable .