腹腔镜下修补手术治疗胃十二指肠溃疡穿孔的临床疗效分析

Clinical efficacy of laparoscopic repair on patients with perforated gastroduodenal ulcers

目的分析腹腔镜下修补手术对胃十二指肠溃疡穿孔(PGDU)患者临床疗效影响。方法选取2011年3月~2014年5月间我院行穿孔修补手术的PGDU患者68例,根据患者意愿按手术方式不同将其分成两组,观察组(34例)行腹腔镜下修补手术,对照组(34例)行开腹修补手术。观察患者手术时间、术后VAS评分、术中出血量、住院时间、术后胃肠功能恢复、术后使用抗生素时间及并发症情况,观察患者白细胞计数、中性粒细胞百分比、血清C反应蛋白(CRP)、IL-6、TNF-α含量改变情况。结果观察组患者手术时间、术后VAS评分、术中出血量、住院时间、术后恢复胃肠功能、术后使用抗生素时间及并发症发生率优于对照组,差异有统计学意义(P<0.05);术后第1、3、5天观察组白细胞计数、中性粒细胞百分比、血清CRP、TNF-α及IL-6含量均比对照组低,差异有统计学意义(P<0.05)。结论腹腔镜下进行PGDU修补手术对患者创伤小,手术后并发症少,机体炎症反应轻,恢复较快。

Objective To analyze the effect of laparoscopic repair on patients with perforated gastroduodenal ulcers(PGDU).Methods 68 PGDU patients undergoing perforation repair in our hospital from March 2011 to May 2014 were selected and divided into two groups according to the patient’s wishes.The observation group(n=34)underwent laparoscopic repair surgery.The control group(n=34)underwent laparotomy.The patient's operative time,postoperative VAS score,intraoperative blood loss,length of stay,postoperative gastrointestinal function recovery,postoperative antibiotic use,and complications were observed.The changes of white blood cell count,neutrophil percentage,serum C-reactive protein(CRP),IL-6 and TNF-αcontent were observed.Results The operative time,postoperative VAS score,intraoperative blood loss,length of hospital stay,postoperative gastrointestinal function recovery,postoperative antibiotic use time,and complication rate were better in the observation group than those in the control group.The difference was statistically significant(P<0.05);On the first,third,fifth day after operation,the white blood cell count,percentage of neutrophils,serum CRP,TNF-αand IL-6 levels in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion Laparoscopic PGDU repair surgery has less trauma,fewer postoperative complications,milder inflammatory response,less trauma and faster recovery to the patient.