腹腔镜与开腹胃十二指肠溃疡穿孔修补术的比较研究

Comparative study of laparoscopic and open repair of gastroduodenal ulcer perforation

目的比较腹腔镜胃十二指肠溃疡穿孔修补术和开腹胃十二指肠溃疡穿孔修补术的临床效果。方法回顾性分析2005年10月—2018年2月上海市松江区泗泾医院收治的117例胃十二指肠溃疡穿孔患者的病例资料,其中男性86例,女性31例;平均年龄35.56岁,年龄范围为17~68岁。根据手术方法不同将患者分为腹腔镜组(n=56)和开腹组(n=61)。其中腹腔镜组患者行腹腔镜胃十二指肠溃疡穿孔修补术,开腹组患者行开腹胃十二指肠溃疡穿孔修补术。比较两组患者的手术时间、术中出血量、术后肛门首次排气时间、镇痛剂使用率、住院时间、机体炎症反应[术前及术后24、72、120 h的外周血白细胞计数(WBC)、C反应蛋白(CRP)水平]、术后并发症(术后切口感染、切口裂开、胃十二指肠瘘、腹腔脓肿、粘连性肠梗阻、肺部感染)。计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验;计数资料组间比较采用χ^2检验。结果两组患者均顺利完成手术,腹腔镜组无中转开腹病例。腹腔镜组和开腹组患者的术中出血量[(15.3±9.5) ml比(30.5±11.3) ml,P<0.001]、肛门首次排气时间[(56.5±9.8) h比(83.8±15.6) h,P<0.001]、镇痛剂使用率(10.71%比52.46%,P<0.005)、住院时间[(7.5±1.5) d比(10.0±3.4) d,P<0.001]相比,差异均具有统计学意义。术后24、72、120 h的WBC及CRP相比,腹腔镜组也明显优于开腹组[WBC:24 h,(14.55±3.44)×10^9/L比(16.02±4.12)×10^9/L,P=0.020;72 h,(10.25±2.32)×10^9/L比(14.22±3.29)×10^9/L,P<0.001;120 h,(8.12±3.11)×10^9/L比(11.58±2.33)×10^9/L,P<0.001。CRP: 24 h,(50.35±13.73) mg/L比(80.11±13.56) mg/L,P<0.001;72 h,(29.37±7.81) mg/L比(53.57±8.05) mg/L,P<0.001;120 h,(17.71±7.01) mg/L比(34.35±7.72) mg/L,P<0.001],差异具有统计学意义。两组患者的手术时间和术后并发症发生率比较,差异均无统计学意义(P>0.05)。结论与开腹胃十二指肠溃疡穿孔修补术相比,腹腔镜胃十二指肠溃疡穿孔修补术手术创伤更小、机体炎症反应更轻,术后并发症发生率虽无统计学意义,但从实际数据上来看,并发症的例数更少,是目前治疗胃十二指肠溃疡穿孔更佳的术式。

Objective To compare the clinical effects of laparoscopic repair and open repair of gastroduodenal ulcer perforation. Methods Retrospective analysis was performed on 117 patients with perforated gastroduodenal ulcer admitted to Sijing Hospital of Shanghai Songjiang District from October 2005 to February 2018, including 86 males and 31 females. The average age was 35.56 years with a range from 17 to 68 years. Patients were divided into two groups according to different surgical methods: laparoscopic group (n=56) and open group (n=61). Patients in the laparoscopic group were received laparoscopic repair for perforated gastroduodenal ulcer, while patients in the open group received open repair for perforated gastroduodenal ulcer. Comparison of two groups of patients with operation time, intraoperative blood loss, postoperative first anal exhaust time, analgesic utilization rate, length of hospital stay, the body′s inflammatory response [preoperative and 24 h, 72 h, 120 h of postoperative peripheral white blood cell (WBC)], C-reactive protein level (CRP), postoperative complications (postoperative incision infection, incision dehiscence, gastric duodenal fistula, abdominal abscess, adhesion intestinal obstruction and lung infection). Measurement data were expressed as mean±standard deviation (Mean±SD), and t-test was used for comparison between groups;count data were compared by Chi-square test. Results All the patients in the two groups successfully completed the operation, and there were no cases transferred to laparotomy in the laparoscopic group. Intraoperative blood loss[(15.3±9.5) ml vs (30.5±11.3) ml, P<0.001], time of first anal exhaust[(56.5±9.8) h vs (83.8±15.6) h, P<0.001], analygesic utilization rate (10.71% vs 52.46%, P<0.005), and length of hospital stay [(7.5±1.5) d vs (10.0±3.4) d, P<0.001] of the laparoscopic group were significantly better in the open group, the differences were statistically significant. The WBC and CRP at 24 h, 72 h and 120 h after surgery of the laparoscopic group were also significantly better than in the open group [WBC: 24 h,(14.55±3.44)×10^9/L vs (16.02±4.12)×10^9/L, P=0.020;72 h,(10.25±2.32)×10^9/L vs (14.22±3.29)×10^9/L, P<0.001;120 h,(8.12±3.11)×10^9/L vs (11.58±2.33)×10^9/L, P<0.001. CRP: 24 h,(50.35±13.73) mg/L vs (80.11±13.56) mg/L, P<0.001;72 h,(29.37±7.81) mg/L vs (53.57±8.05) mg/L, P<0.001;120 h,(17.71±7.01) mg/L vs (34.35±7.72) mg/L, P<0.001], the differences were statistically significant. There was no significant difference in operation time and postoperative complications between the two groups (P>0.05). Conclusion Compared with open gastroduodenal ulcer perforation repair, laparoscopic gastroduodenal ulcer perforation repair surgery trauma are smaller, and the body′s inflammatory response are lighter, postoperative complications is no statistical significance, but will look from actual data, the cases of complications is less, is now a better surgical treatment of gastroduodenal ulcer perforation.