腹腔镜辅助小切口与开腹手术治疗老年胃十二指肠溃疡穿孔的比较

Comparison Between Laparoscopy Assisted Small Incision Surgery and Laparotomy for Perforated Gastroduodenal Ulcer in Elderly Patients

目的探讨腹腔镜辅助小切口手术治疗老年（≥60岁）胃十二指肠溃疡穿孔的应用价值。方法回顾我院2012年1月～2014年12月老年胃十二指肠溃疡穿孔患者96例资料,其中小切口组（腹腔镜辅助小切口修补）和开腹组各48例。2组年龄、性别、穿孔时间、穿孔大小及术前合并症等差异无显著性,比较2组手术时间、术中出血量、术后胃肠功能恢复时间、住院时间和术后并发症发生率。结果小切口组4例延长切口完成手术。与开腹组相比,小切口组术中出血少[（25.3±11.2）ml vs.（59.1±17.8）ml,t=-10.747,P=0.000],术后排气早[（25.0±4.9）h vs.（30.0±6.0）h,t=-4.437,P=0.000],住院时间短[（7.3±3.2）d vs.（10.6±4.7）d,t=-3.894,P=0.000],并发症少[13.6%（6/44）vs.37.5%（18/48）,χ^2=6.780,P=0.009],但手术时间长[（56.3±9.4）min vs.（50.4±12.7）min,t=2.525,P=0.013]。结论腹腔镜辅助小切口手术治疗老年胃十二指肠溃疡穿孔易操作,创伤小,恢复快,术后并发症少,是老年胃十二指肠溃疡穿孔较为理想的手术方式。

Objective To evaluate the application value of laparoscopy assisted small incision surgery for perforated gastroduodenal ulcer in elderly patients（ ≥60 years old）. Methods A total of 96 elderly patients with perforated gastroduodenal ulcer from January 2012 to December 2014 in our hospital,including 48 cases of laparoscopic assisted small incision repair and 48 cases of laparotomy,were retrospectively analyzed. No statistical significances were noted in the age,gender,time and size of perforation and preoperative complications between the two groups. The operative time,intraoperative blood loss,postoperative flatus time,hospital stay and postoperative complications were compared between the two groups. Results In the small incision group,incision lengthening was required in 4 patients. The intraoperative blood loss,postoperative flatus time,hospital stay and postoperative complications in the small incision group were significantly less than those in the laparotomy group [（ 25. 3 ± 11. 2） ml vs.（ 59. 1 ±17. 8） ml,t =- 10. 747,P = 0. 000;（ 25. 0 ± 4. 9） h vs.（ 30. 0 ± 6. 0） h,t =- 4. 437,P = 0. 000;（ 7. 3 ± 3. 2） d vs.（ 10. 6 ±4. 7） d,t =- 3. 894,P = 0. 000; 13. 6%（ 6 /44） vs. 37. 5%（ 18 /48）,χ~2= 6. 780,P = 0. 009]. However,the operative time in the small incision group was significantly longer than that in the laparotomy group [（ 56. 3 ± 9. 4） min vs.（ 50. 4 ± 12. 7） min,t =2. 525,P = 0. 013]. Conclusion Laparoscopy assisted mall incision surgery for perforated gastroduodenal ulcer shows superiorities such as easy performance,minimal trauma,rapid recovery,and less postoperative complications,being an ideal surgery method in elderly patients.