腹腔镜诊治不典型胃十二指肠溃疡穿孔的临床体会(附29例报告)

Clinical experience of laparoscopic diagnosis and treatment of atypical gastroduodenal ulcer perforation:with a report of 29 cases

目的：探讨腹腔镜在不典型胃十二指肠溃疡穿孔诊断与治疗中的优越性。方法：回顾分析2009年10月至2014年6月为29例不典型胃十二指肠溃疡穿孔患者行腹腔镜手术治疗的临床资料。术中探查腹腔,行腹腔镜胃十二指肠溃疡穿孔修补术。结果：29例手术均获成功,无一例中转开腹。手术时间33~75 min,平均（51.9±11.6）min。除1例合并脑血栓后遗症患者不能下床活动,其余患者下床活动时间24~48 h,平均（35.7±8.1）h。术后住院6~10 d,平均（6.8±1.0）d。均无腹腔脓肿、梗阻等并发症发生,切口均一期愈合,痊愈出院。本组病理结果均为溃疡病灶。术后3个月复查胃镜,提示溃疡病灶均愈合。结论：对于不典型胃十二指肠溃疡穿孔,腹腔镜手术可达到诊断与治疗的双重目的,既可避免误诊、误治或因治疗性观察而延误手术时机,又可将患者的损伤降至最低。严格把握手术适应证,具备熟练的腔镜操作技巧,术后规范的内科治疗,腹腔镜诊治不典型胃十二指肠溃疡穿孔可取得安全、满意的效果。

Objective：To discuss the advantages of laparoscopy in the diagnosis and treatment of atypical gastroduodenal ulcer perforation. Methods： Clinical data of 29 patients suffering from atypical gastroduodenal ulcer perforation who underwent laparoscopic surgery from Oct. 2009 to Jun. 2014 were retrospectively analyzed. The abdominal cavity was explored in operation, laparoscopic repair of perforation was performed. Results：All the 29 laparoscopic operations were performed successfully without conversion to open opera- tion, abdominal infection or obstruction. The operative time was 33-75 min, the average time was （51.9 ＋ 11.6） min. The time of ambu- lation after operation was 24-48 h, the average time was （35.7 ＋ 8.1 ） h （ 1 patient with sequel of cerebral intarction could not walk）. The postoperative hospital stay was 6-10 d,with the average of （6.8 ＋ 1.0） d. Incisions healed by first intention and patients were dis- charged from hospital. The results of biopsy were ulcerative lesions. 3 months later the examination of gastroscopy showed that all ulcers healed. Conclusions： For atypical gastroduodenal ulcer perforation, laparoscopy can achieve the dual goals of diagnosis and treatment, a- void delay of operative opportunity caused by misdiagnosis, mistreatment and therapeutic observation, decrease trauma of patients as much as possible. Sufficient supervision of operative indications, proficient laparoscopic operation, standardized medical treatment can a- chieve safe and satisfied therapeutic effect.