腹腔镜下穿孔修补术治疗老年胃溃疡合并胃穿孔的效果观察

Effect observation on laparoscopic perforation repair in the treatment of elderly gastric ulcer complicated with gastric perforation

目的研究腹腔镜下穿孔修补术用于老年胃溃疡合并胃穿孔患者治疗中的疗效。方法 148例老年胃溃疡合并胃穿孔患者,根据手术方式不同分为开腹组(76例)与腹腔镜组(72例)。开腹组患者给予开腹穿孔修补术治疗,腹腔镜组患者给予腹腔镜下穿孔修补术治疗。对比两组患者的手术治疗效果。结果两组手术时间比较差异无统计学意义(P>0.05);腹腔镜组术中出血量、术后下床活动时间、住院时间分别为(18.3±4.5)ml、(1.47±0.22)d、(6.81±1.26)d,均优于开腹组的(42.9±8.1)ml、(2.84±0.36)d、(10.45±1.74)d,差异均具有统计学意义(P<0.05);腹腔镜组术后并发症发生率5.56%低于开腹组的17.11%,差异具有统计学意义(P<0.05)。术后1 h两组患者血清胃泌素(GAS)水平比较差异无统计学意义(P>0.05);腹腔镜组术后6、24、48 h的血清GAS水平分别为(42.1±4.5)、(52.1±4.9)、(64.3±8.2)pg/ml,均明显高于开腹组的(38.2±5.2)、(45.3±5.4)、(53.8±7.6)pg/ml,差异均具有统计学意义(P<0.01);腹腔镜组患者术后肛门排气时间、肠鸣音恢复时间分别为(31.1±6.3)、(14.5±3.5)h,均短于开腹组的(39.4±8.9)、(22.3±4.4)h,差异均具有统计学意义(P<0.01)。术后1、3、5 d,腹腔镜组患者视觉模拟评分法(VAS)评分分别为(3.59±0.46)、(2.05±0.13)、(1.18±0.10)分,均低于开腹组的(4.51±0.42)、(3.27±0.28)、(1.93±0.18)分,差异均具有统计学意义(P<0.05)。结论腹腔镜下穿孔修补术对老年胃溃疡合并胃穿孔患者的创伤更小,患者术后的胃肠动力恢复更快,术后可早期下床、进食,缩短住院时间,对于符合腹腔镜手术适应证的患者应尽量优先选择腹腔镜手术治疗。

Objective To study the efficacy of laparoscopic perforation repair in the treatment of elderly gastric ulcer complicated with gastric perforation. Methods A total of 148 elderly patients with gastric ulcer complicated with gastric perforation as study subjects were divided by different surgical methods into laparotomy group（76 cases） and laparoscopic group（72 cases）. The laparotomy group was treated with open perforation repair, and laparoscopic group was treated with laparoscopic perforation repair. Surgical treatment effect in two groups was compared. Results Both groups had no statistically significant difference in operation time（P0.05）. The laparoscopic group had better intraoperative bleeding volume, postoperative offbed activity time and hospitalization time respectively as（18.3±4.5） ml,（1.47±0.22） d and（6.81±1.26） d than（42.9±8.1） ml,（2.84±0.36） d and（10.45±1.74） d in laparotomy group, and the difference was statistically significant（P0.05）. The laparoscopic group had lower postoperative complication rate as 5.56% than 17.11% in the laparotomy group, and the difference was statistically significant（P0.05）. Both groups had no statistically significant difference in serum gastrin（GAS）level in postoperative 1 h（P0.05）.The laparoscopic group had obviously higher serum GAS level in postoperative 6,24 and 48 h respectively as（42.1±4.5）,（52.1±4.9）and（64.3±8.2）pg/ml than（38.2±5.2）,（45.3±5.4）and（53.8±7.6）pg/ml in laparotomy group,and their difference was statistically significant（P0.01）.The laparoscopic group had shorter postoperative anal exhaust time,bowel sounds recovery time respectively as（31.1±6.3）and（14.5±3.5）h than（39.4±8.9）and（22.3±4.4）h in laparotomy group,and their difference was statistically significant（P0.01）.In postoperative 1,3 and 5 d,the laparoscopic group had lower visual analogue scale（VAS）score respectively as（3.59±0.46）,（2.05±0.13）and（1.18±0.10）points than（4.51±0.42）,（3.27±0.28）and（1.93±0.18）points in laparotomy group,and their difference was statistically significant（P0.05）.Conclusion For elderly patients with gastric ulcer complicated with gastric perforation,laparoscopic perforation repair provides less trauma,faster postoperative gastrointestinal motility recovery,and early ambulation and food intake and shorter hospitalization time.Laparoscopic surgery should be the first choice for patients with indications for laparoscopic surgery.