腹腔镜下尼龙绳联合双臂钳修补术治疗急性胃穿孔患者的效果

Effects of laparoscopic nylon cord combined with double-arm forceps repair in patients with acute gastric perforation

目的:观察腹腔镜下尼龙绳联合双臂钳修补术治疗急性胃穿孔患者的效果。方法:回顾性分析2019年5月至2020年10月该院收治的64例急性胃穿孔患者的临床资料,按照治疗方法不同分为对照组和观察组各32例。对照组采用胃部分切除术治疗,观察组采用腹腔镜下尼龙绳联合双臂钳修补术治疗,比较两组手术情况及术后恢复情况、胃肠激素指标[促胃液素(GAS)、血管活性肠肽(VIP)]水平、应激反应指标[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞计数(WBC)]水平及并发症发生率。结果:观察组手术时间、引流管拔除时间、肠鸣音恢复时间、肛门排气时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后3 d,观察组GAS、VIP水平均高于对照组,差异有统计学意义(P<0.05);观察组CRP、TNF-α、IL-6、WBC水平均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为6.25%,低于对照组的28.13%,差异有统计学意义(P<0.05)。结论:腹腔镜下尼龙绳联合双臂钳修补术治疗急性胃穿孔患者,可缩短手术时间,减少出血量,加快术后康复和胃动力恢复,降低应激反应和并发症发生率,其效果优于胃部分切除术治疗。

Objective:To observe effects of laparoscopic nylon cord combined with double-arm forceps repair in patients with acute gastric perforation.Methods:The clinical data of 64 patients with acute gastric perforation admitted to our hospital from May 2019 to October 2020 were retrospectively analyzed.According to different treatment methods,they were divided into control group and observation group,32 cases in each.The control group was treated with partial gastrectomy,while the observation group was treated with laparoscopic nylon cord combined with double-arm forceps repair The operation and postoperative recovery conditions,the gastrointestinal hormone levels[plasma gastrin(GAS),vasoactive intestinal peptide(VIP)],the stress response index levels[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),white blood cell count(WBC)]and the incidences of complications were compared between the two groups.Results:The operation time,the drainage tube removal time,the bowel sound recovery time,the anal exhaust time,and the intraoperative blood loss in the observation group were all less than those in the control group,and the differences were statistically significant(P<0.05).On the 3rd day after the surgery,the levels of GAS and VIP in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of CRP,TNF-α,IL-6 and WBC in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 6.25%,which was lower than 28.13%in the control group,and the difference was statistically significant(P<0.05).Conclusions:Laparoscopic nylon cord combined with double-arm forceps repair in the patients with acute gastric perforation can shorten the operation time,reduce the amount of bleeding,speed up the postoperative recovery and the gastric motility recovery,and reduce the incidence of stress response and complications.Moreover,it is superior to partial gastrectomy.