腹腔镜与开腹手术治疗胃十二指肠溃疡穿孔的临床研究

Laparoscopic versus open surgery in the treatment of perforated gastroduodenal ulcer

目的:探讨腹腔镜与开腹手术治疗胃十二指肠溃疡穿孔的临床效果。方法:收集2014年1月至2015年12月行腹腔镜或开腹手术治疗的163例胃十二指肠溃疡穿孔患者的临床资料,其中腹腔镜组63例,开腹组100例。收集并分析两组患者基本情况、手术资料、术后恢复等情况。结果:与开腹组相比,腹腔镜组手术时间[(80.7±23.9)min vs.(63.3±20.5)min]更长,手术费用[(2 225.7±252.4)元vs.(1 701.8±397.4)元]、麻醉费用[(1 443.8±342.9)元vs.(1 084.2±425.6)元]更高,但术中出血少[(8.0±7.5)ml vs.(11.5±9.7)ml],总住院时间[(8.3±3.5)d vs.(13.9±7.9)d]、留置胃管时间[(4.3±1.7)d vs.(5.2±1.5)d]、禁食时间[(4.9±1.2)d vs.(6.5±2.0)d]、留置引流管时间[(6.5±1.6)d vs.(9.0±3.6)d]更短(P<0.05),术后并发症发生率(6.3%vs.25.0%)、尿管留置率(61.9%vs.89.0%)低。两组总住院费用[(17 419.0±10 364.7)元vs.(20 412.4±17 450.4)元]差异无统计学意义(P>0.05)。结论:腹腔镜手术安全、有效,是治疗胃十二指肠溃疡穿孔的重要手段。

Objective：To assess the safety and effectiveness of laparoscopic and open surgery for the treatment of perforated gastroduodenal ulcer. Methods：A total of 163 patients who underwent laparoscopic or open repair of perforated gastroduodenal ulcer in Affiliated Shantou Hospital of Sun Yat-sen University from Jan. 2014 to Dec. 2015 were collected and retrospectively analyzed with the demographic data,data of surgery and postoperative recovery. Sixty-three patients underwent laparoscopic repair and the other 100 underwent open repair. Results： Compared with open repair,laparoscopic surgery was associated with longer duration of the operation[（80. 7 ± 23. 9） min vs.（63. 3 ± 20. 5） min],more surgical expenses [（2 225. 7 ± 252. 4） yuan vs.（1 701. 8 ± 397. 4） yuan]and anesthetic cost [（1 443. 8 ± 342. 9） yuan vs.（1 084. 2 ± 425. 6） yuan],less blood loss during surgery [（8. 0 ± 7. 5） ml vs.（11. 5 ±9. 7） ml],total hospital stay [（8. 3 ± 3. 5） d vs.（13. 9 ± 7. 9） d],duration of gastric tube retention [（ 4. 3 ± 1. 7） d vs.（ 5. 2 ±1. 5） d],fasting time [（4. 9 ± 1. 2） d vs.（6. 5 ± 2. 0） d],time of drainage tube retention [（6. 5 ± 1. 6） d vs.（9. 0 ± 3. 6） d],postoperative complications（6. 3% vs. 25. 0%） and rate of urinary catheter retention（ 61. 9% vs. 89. 0%）. There were no significant differences in total hospitalization expenses [（17 419. 0 ± 10 364. 7） yuan vs.（20 412. 4 ± 17 450. 4） yuan]between the two groups.Conclusions：Laparoscopic repair is safe,effective and minimally invasive in the treatment of perforated gastroduodenal ulcer.