腹腔镜技术在老年胃十二指肠溃疡穿孔患者中的应用

The efficacy of laparoscopic perforation repair in treatment of elderly patients with gastroduodenal ulcer perforation

目的：探讨腹腔镜手术在老年胃十二指肠溃疡穿孔患者中的临床应用价值。方法：回顾分析2010年3月至2013年10月收治的94例行腹腔镜胃十二指肠溃疡穿孔修补术老年患者的临床资料,观察其治疗效果。结果：手术均顺利完成,手术时间平均（72.2±8.4）min,术中出血量平均（30.4±7.4）ml,术后开始下床时间平均（20.6±4.8）h,肠道恢复通气时间（30.6±6.9）h,术后平均住院（6.4±1.9）d,术后镇痛药使用率20.2%。术后发生肺部感染4例,腹腔脓肿1例,泌尿系感染1例,感染性休克1例,并发症发生率7.4%,经抗炎、支持对症等治疗后好转。术后1个月查胃镜提示患者溃疡均愈合良好,病理检查未见癌细胞。术后随访6~18个月,均无复发。结论：腹腔镜技术应用于老年胃十二指肠溃疡穿孔患者是安全、可行的,具有创伤小、康复快、并发症少等优点,值得在临床上推广应用。

Objective： To investigate the clinical effects of laparoscopic perforation repair in elderly patients with gastroduodenal ulcer perforation. Methods： Clinical data of 94 elderly patients with acute perforation of gastroduodenal ulcer who underwent laparoscopic repair from Mar. 2010 to Oct. 2013 were retrospectively analyzed. Their therapeutic effects were observed. Results： All the laparoscopic operations were successfully performed. The operative time was（ 72. 2 ± 8. 4） min,the blood loss was（ 30. 4 ± 7. 4） ml,the postoperative ambulation time was（ 20. 6 ± 4. 8） h,the intestine functional recovery time was（ 30. 6 ± 6. 9） h,the postoperative hospital stay was（ 6. 4 ± 1. 9） d,the incidence of the postoperative requirement of analgesic was 20. 2%. Postoperative complications included lung infection（ 4 cases）,abdominal abscess（ 1 case）,urinary tract infection（ 1 case）,septic shock（ 1 case）,the incidence of complications was 7. 4%. All the patients with postoperative complications were cured after anti-inflammatory and conservative treatment.Gastroscopy prompted that ulcers had healed in all the patients one month after operation,no cancer cells were found. Patients were followed up for 6 to 18 months,there were no symptoms of ulcer recurrence. Conclusions： The laparoscopic repair is a safe,feasible and minimally invasive method for elderly patients with gastroduodenal ulcer perforation with the advantages of little operation wound,quick recovery and few complications,it is worth promotion and application in clinic.