探究微创腹腔镜与传统开腹修补术治疗老年上消化道穿孔术后的并发症及预后差异

To Explore the Difference of Complications and Prognosis between Elderly Patients with Upper Gastrointestinal Perforation after Minimally Invasive Laparoscopic and Traditional Open Abdominal Repair

目的探究与分析微创腹腔镜与传统开腹修补术治疗老年上消化道穿孔术后并发症及预后差异。方法选取我院自2013年8月至2015年8月收治的80例老年上消化道穿孔患者,按照手术方式分为开腹组与腹腔镜组,每组各40例,对比两组患者切口长度、术中出血量、术后疼痛评分、术后进食时间、术后肛门排气时间、切口感染、肺部感染、腹腔感染发生率及病死率。结果腹腔镜组较开腹组相比切口长度缩短、术中出血量减少、术后疼痛评分降低、术后进食时间缩短、术后肛门排气时间缩短,具有统计学意义(P<0.05)。腹腔镜组较开腹组相比切口感染率、肺部感染率、腹腔感染率合计相比均明显降低,具有统计学意义(P<0.05)。开腹组与腹腔镜组的病死率相比均无明显差异(P>0.05)。结论微创腹腔镜相比于传统开腹修补术治疗老年上消化道穿孔的临床效果更加显著,术后并发症发生率较低,未增加病死率,安全性较高,值得推广与应用。

Objective To investigate and analyze the differences in complications and prognosis between elderly patients with upper gastrointestinal perforation after minimally invasive laparoscopic and conventional open abdominal repair.Methods Eighty elderly patients with upper gastrointestinal perforation admitted to our hospital from August 2013 to August 2015 were enrolled.The patients were divided into open group and laparoscopic group according to the operation.Each group had 40 cases.Length,intraoperative blood loss,postoperative pain score,postoperative feeding time,postoperative anal exhaust time,wound infection,pulmonary infection,incidence of abdominal infection,and mortality.Results Compared with the open group,the laparoscopic group had shorter incision length,less intraoperative blood loss,lower postoperative pain score,shorter postoperative feeding time,and shorter postoperative anal exhaust time(P<0.05).Compared with the open group,the laparoscopic group had significantly lower incision infection rate,lung infection rate,and abdominal infection rate,which was statistically significant(P<0.05).There was no significant difference in mortality between the open group and the laparoscopic group(P>0.05).Conclusion Minimally invasive laparoscopic surgery is more effective than traditional open abdominal repair in the treatment of elderly upper gastrointestinal perforation.The incidence of postoperative complications is low,the mortality is not increased,and the safety is high.It is worthy of promotion and application.