改良五孔法腹腔镜胃十二指肠溃疡穿孔修补术的应用价值

Application value of modified five-port laparoscopic repair of perforated gastroduodenal ulcer

目的:探讨改良五孔法在困难腹腔镜胃十二指肠溃疡穿孔修补术中的临床应用价值。方法:根据病例纳入与排除标准,筛选2017年12月至2020年5月收治的50例胃十二指肠溃疡穿孔患者,研究组(n=25)行改良五孔法腹腔镜穿孔修补术,对照组(n=25)行非改良五孔法腹腔镜穿孔修补术,对比分析两组临床疗效。结果:研究组与对照组手术时间分别为(67.0±29.5)min与(85.4±51.5)min,术后住院时间分别为(10.4±2.7)d与(10.9±4.8)d,术后分别发生消化道瘘1例与2例,术后均死亡1例,对照组发生切口感染3例;两组手术时间、术后住院时间、消化道瘘、死亡率与切口感染率差异无统计学意义(P>0.05);研究组中转开腹1例,对照组为6例,两组差异有统计学意义(P<0.05)。结论:改良五孔法行腹腔镜胃十二指肠溃疡穿孔修补安全、有效,尤其对于复杂困难病例优势明显,降低了中转开腹率,具有一定的临床应用价值。

Objective:To study the clinical application value of modified five-port technique in the difficult laparoscopic repair of perforated gastroduodenal ulcer.Methods:According to the criteria of case inclusion and exclusion,50 patients with perforation of gastroduodenal ulcer were selected from Dec.2017 to May 2020.The study group(n=25)underwent modified five-port laparoscopic perforation repair,while the control group(n=25)underwent non-modified five-port laparoscopic perforation repair.The clinical effects of the two groups were compared and analyzed.Results:In study group and control group,the mean operation time was(67.0±29.5)min and(85.4±51.5)min respectively,the mean postoperative hospital stay was(10.4±2.7)d and(10.9±4.8)d respectively,the number of postoperative digestive tract fistula was 1 and 2 respectively,the death number was 1 and 1 respectively,the number of incision infection was 0 and 3 respectively.There was no significant difference in operation time,postoperative hospitalization time,digestive tract fistula,death and incision infection between the two groups(P>0.05).In study group and control group,the conversion to laparotomy occurred in 1 patient and 6 patients respectively,the difference was statistically significant(P<0.05).Conclusions:The modified five-port laparoscopic repair of perforated gastroduodenal ulcer is safe and effective,especially for complex and difficult cases.This procedure has obvious advantages,reduces the conversion rate to laparotomy,and has certain clinical application value.