3D和2D腹腔镜胃十二指肠穿孔修补术的疗效分析

Efficacy analysis of three-dimensional and two-dimensional laparoscopic repairs of gastroduodenal perforation

目的比较3D和2D腹腔镜胃十二指肠穿孔修补术的临床疗效。方法采用回顾性队列研究方法。收集2014年7月至2017年12月赣州市人民医院收治的92例行腹腔镜胃十二指肠穿孔修补术患者的临床病理资料。44例患者行3D腹腔镜胃十二指肠穿孔修补术，设为3D腹腔镜组；48例患者行2D腹腔镜胃十二指肠穿孔修补术，设为2D腹腔镜组。观察指标：（1）术中及术后恢复情况比较。（2）术后药物敏感试验及病理学检查情况。（3）随访情况。采用门诊和电话方式进行随访，了解患者出院后并发症发生情况。随访时间截至2018年8月。正态分布的计量资料以x±s表示，组间比较采用t检验。偏态分布的计量资料以肘（范围）表示。计数资料组间比较采用疋。检验。结果（1）术中及术后恢复情况比较：92例患者均顺利完成腹腔镜胃十二指肠穿孔修补术，无中转开腹和围术期死亡患者。3D腹腔镜组患者手术时间、穿孔处取病理学检查组织时间、穿孔修补时间、术中出血量、术后肛门首次排气时问分别为（60±8）min、（36±6）s、（137±12）s、（9．0±2．2）mL、（23．8±2．8）h，2D腹腔镜组患者上述指标分别为（70±9）rain、（39±6）s、（143±14）s、（10．3±2．5）mL、（25．9±4．8）h，两组患者上述指标比较，差异均有统计学意义（t=5．795，2．779，2．215，7．740，2．570，P〈0．05）。3D腹腔镜组患者术后3例发生并发症，分别为肺部感染、局限性肺不张、谵妄；2D腹腔镜组患者术后2例发生并发症，分别为肺部感染、心力衰竭。发生并发症患者均予对症支持治疗后好转。两组患者术后并发症发生例数比较，差异无统计学意义（X2=0．010．P〉0．05）。（2）术后药物敏感试验及病理学检查情况：两组患者腹腔积液细菌培养均为阳性，并获得相应药物敏感试验结果；穿孔处病理学检查均未发现恶性肿瘤细胞。（3）随访情况：84例患者获得术后随访，随访时间为1～12个月，中位随访时间为3个月。随访期间无相关并发症发生。结论与2D腹腔镜胃十二指肠穿孔修补术比较，3D腹腔镜手术同样安全可行，且手术时间、穿孔修补时间、穿孔处取病理学检查组织时间、术中出血量、术后肛门首次排气时间均优于2D腹腔镜手术。

Objective To compare the clinical efficacy of three-dimensional （3D） and two-dimensional （2D） laparoscopic repairs of gastroduodenal perforation. Methods The retrospective cohort study was conducted. The clinieopathological data of 92 patients who underwent laparoseopic repair of gastroduodenal perforation from July 2014 to December 2017 in the Ganzhou People＇s Hospital were collected. Forty-four patients undergoing 3D laparoscopic repair and 48 patients undergoing 2D laparoscopie repair were respectively allocated into the 3D and 2D groups. Observation indicators ： （ 1 ） comparisons of intra- and post-operative recovery ; （2） postoperative drug sensitivity test and pathological examination; （3） follow-up. Follow-up using outpatient examination and telephone interview was performed to detect complications after discharging from hospital up to August 2018. Measurement data with normal distribution were represented as x±s and comparison between groups was analyzed using t test. Measurement data with skewed distribution were described as M （range）. Comparison between groups of count data was analyzed using the ehi-square test. Results （ 1 ） Comparison of intra- and post-operative recovery ： 92 patients underwent successfully laparoscopic gastroduodenal perforation, without conversion to open surgery or perioperative death. The operation time, time of pathological tissue extract at the perforation, time of perforation repair, volume of intraoperative blood loss and time of initial anal exsufflation were respectively （60 ± 8 ） minutes, （36 ± 6） seconds, （ 137± 12） seconds, （9.0±2.2） mL, （23.8±2.8） hours in the 3D group and （70±9） minutes, （39±6） seconds, （ 143± 14） seconds, （ 10.3 ± 2.5 ） mL, （ 25.9± 4.8 ） hours in the 2D group, with statistically significant differences between groups （t=5.795, 2.779, 2.215, 7.740, 2.570, P〈0.05）. Three patients in the 3D group were complicated with puhnonary infection, localized atelectasis and delirium. Two patients in the 2D group were complicated with pulmonary infection and heart failure. Patients with complications between groups were improved by symptomatic and supporting treatment. There was no statistically significant difference in cases with postoperative complications between groups （X2 = 0.010, P〉0.05）. （2） Postoperative drug sensitivity test and pathological examination： the ascites culture of peritoneal effusion in the 2 groups was positive, and drug susceptibility results were obtained. No malignant cells at the perforation were found in pathological examination. （3） Follow-up： 84 patients were followed up for 1-12 months, with a median time of 3 months. There was no related complication after discharging from hospital. Conclusion Compared with 2D laparoscopic repair of gastroduodenal perforation, 3D laparoscopic repair of gastroduodenal perforation not only is safe and feasible, but also has advantages of shorter operation time, perforation repair time and time of pathological tissue extract at the perforation, less volume of intraoperative blood loss and shorter time of initial anal exsufflation.