经脐单孔腹腔镜治疗胃十二指肠溃疡穿孔的临床研究

Clinical Study of Transumbilical Single-Port Laparoscopic Treatment of Perforated Gastroduodenal Ulcer

目的:探讨经脐单孔腹腔镜修补术治疗胃十二指肠溃疡的疗效及其对机体炎症反应的影响。方法:选取2016年10月—2020年5月我院收治的胃十二指肠溃疡穿孔患者90例,采用随机数字表法分为单孔组(n=47)和多孔组(n=43),单孔组行经脐单孔腹腔镜胃十二指肠溃疡穿孔修补术,多孔组行传统多孔腹腔镜胃十二指肠溃疡穿孔修补术。比较两组患者手术情况、胃肠功能恢复情况及术后并发症发生情况;对比两组患者术前、术后1 d、术后7 d及术后14 d降钙素原(PCT)、白细胞介素-6(IL-6)及总免疫球蛋白E(T-IgE)水平。结果:与多孔组比较,单孔组患者术后镇痛剂使用率(18.60%vs 4.26%)、住院时间[(8.54±1.68)vs(7.22±1.43)]明显降低(P<0.05),术后肠鸣音出现时间[(31.15±4.13)h vs(27.70±3.36)h]、胃肠功能恢复时间[(40.74±6.08)min vs(33.58±5.63)min]、首次排气时间[(51.73±6.68)vs(41.13±5.67)]及首次排便时间[(59.52±8.38)vs(46.48±7.12)]均显著缩短(P<0.05)。单孔组术后7 d、14 d,血清PCT、IL-6及T-IgE水平显著低于多孔组[术后7 d,PCT:(0.32±0.15)ng/mL vs(0.43±0.17)ng/mL,IL-6:(1.05±0.26)pg/mL vs(1.15±0.39)pg/mL,T-IgE:(119.59±28.51)IU/mLvs(125.46±25.63)IU/mL;术后14 d,PCT:(0.27±0.11)ng/mL vs(0.37±0.19)ng/mL,IL-6:(0.94±0.41)pg/mL vs(1.06±0.32)pg/mL,T-IgE:(96.51±32.15)IU/mLvs(102.83±21.36)IU/mL],差异有统计学意义(P<0.05)。单孔组患者术后并发症发生率为2.12%,显著低于多孔组(13.95%),差异有统计学意义(P<0.05)。结论:经脐单孔腹腔镜修补术治疗胃十二指肠溃疡穿孔疗效显著,能有效缩短患者住院时间,降低患者术后并发症发生率,促进患者胃肠功能恢复,减轻机体炎症反应,具有较好的临床应用价值。

Objective To investigate the effect of transumbilical single hole laparoscopic repair on gastroduodenal ulcer and its effect on inflammatory response.Methods 90 patients with perforated gastroduodenal ulcer treated in our hospital from October 2016 to may 2020 were randomly divided into single hole group(n=47)and multi hole group(n=43),the single hole group received transumbilical single hole laparoscopic gastroduodenal ulcer perforation repair,and the multi hole group received traditional multi hole laparoscopic gastroduodenal ulcer perforation repair.The operation,gastrointestinal function recovery and postoperative complications were compared between the two groups,the levels of procalcitonin(PCT),interleukin-6(IL-6)and total immunoglobulin E(T-IgE)in the two groups were compared before operation,1 d after operation,7 d after operation and 14 d after operation.Results Compared with the porous group,the use rate of postoperative analgesics(18.60%vs 4.26%)and hospital stay[(8.54±1.68)vs(7.22±1.43)]in the single pore group were significantly lower(P<0.05),and the occurrence time of postoperative bowel sounds[(31.15±4.13)vs(27.70±3.36)],recovery time of gastrointestinal function[(40.74±6.08)vs(33.58±5.63)],first exhaust time[(51.73±6.68)vs(41.13±5.67)]and first defecation time[(59.52±8.38)vs(46.48±7.12)]were significantly shorter(P<0.05).The levels of serum PCT,IL-6 and T-IgE in the single well group were significantly lower than those in the porous group 7 and 14 days after operation[7 d PCT:(0.32±0.15)ng/mL vs(0.43±0.17)ng/mL,IL-6:(1.05±0.26)pg/mL vs(1.15±0.39)pg/mL,T-IgE:(119.59±28.51)IU/mL vs(125.46±25.63)IU/mL.14 d PCT:(0.27±0.11)ng/mL vs(0.37±0.19)ng/mL,IL-6:(0.94±0.41)pg/mL vs(1.06±0.32)pg/mL,T-IgE:(96.51±32.15)IU/mL vs(102.83±21.36)IU/mL,all P<0.05].The incidence of postoperative complications in the single hole group was 2.12%,which was significantly lower than that in the multi hole group(13.95%)(P<0.05).Conclusion Transumbilical single hole laparoscopic repair is effective in the treatment of perforation of gastroduodenal ulcer,it can effectively shorten the hospital stay,reduce the incidence of postoperative complications,promote the recovery of gastrointestinal function and reduce the inflammatory reaction,which has good clinical application value.