腹腔镜胃十二指肠溃疡穿孔修补术的临床价值

Clinical Value of Laparoscopic Repair of Perforated Gastroduodenal Ulcer

目的:研究腹腔镜胃十二指肠溃疡穿孔修补术的临床应用价值。方法:回顾性分析2019年9月—2022年9月于建瓯市立医院外一科接受手术治疗的88例胃十二指肠溃疡穿孔患者,依据手术方案的差异将其分为腹腔镜组(44例,行腹腔镜修补术)、传统组(44例,行传统开腹手术)。比较两组的手术指标(手术时间、术中出血量,以及术后下床时间、排气时间、住院时间),并对比两组胃肠激素、肠黏膜屏障及免疫功能指标,同时观察其并发症情况。结果:腹腔镜组手术时间、住院时间均短于传统组,术后下床时间、排气时间早于传统组,术中出血量少于传统组(P<0.05);术后3 d,腹腔镜组胃泌素(GAS)、血管活性肠肽(VIP)及胃动素(MTL)水平均高于传统组(P<0.05);术后3 d,腹腔镜组一氧化氮(NO)、D-乳酸(D-Lac)、内毒素(ET)及二氧化酶(DAO)水平均低于传统组(P<0.05);术后3 d,腹腔镜组的CD4^(+)、CD4^(+)/CD8^(+)、CD3^(+)水平均明显高于传统组,CD8^(+)水平低于传统组(P<0.05);腹腔镜组并发症发生率为2.27%,低于传统组的18.18%(P<0.05)。结论:腹腔镜胃十二指肠溃疡穿孔修补术可有效减少患者手术出血量,缩短手术时间、术后排气时间、下床时间及住院时间,有利于胃肠功能的早期恢复,并为其肠黏膜屏障的修复提供助力,对免疫功能的优化有重要意义,可降低并发症发生风险,应用价值确切。

Objective:To investigate the clinical application value of laparoscopic repair of perforated gastroduodenal ulcer.Method:A retrospective analysis was made of 88 patients with perforated gastroduodenal ulcer who received surgical treatment in the First Department of Surgery of Jian’ou Municipal Hospital from September 2019 to September 2022.They were divided into laparoscopic group(44 cases,laparoscopic repair)and traditional group(44 cases,traditional laparotomy)according to the difference of surgical schemes.The operation indexes(operation time,intraoperative bleeding,time to get out of bed,time to exhaust,and hospital stay)of the two groups were compared,and the gastrointestinal hormones,intestinal mucosal barrier and immune function indexes of the two groups were compared,and the complications were observed.Result:The operation time and hospital stay in the laparoscopic group were shorter than those in the traditional group,and the time to get out of bed and exhaust gas after operation were earlier than those in the traditional group,and the amount of intraoperative bleeding was less than that in the traditional group(P<0.05);3 d after operation,the levels of gastrin(GAS),vasoactive intestinal peptide(VIP)and motilin(MTL)in the laparoscopic group were higher than those in the traditional group(P<0.05);3 d after operation,the levels of nitric oxide(NO),D-lactic acid(D-Lac),endotoxin(ET)and dioxygenase(DAO)in the laparoscopic group were lower than those in the traditional group(P<0.05);3 d after operation,the levels of CD4^(+),CD4^(+)/CD8^(+)and CD3^(+)in the laparoscopic group were significantly higher than those in the traditional group,and the levels of CD8^(+)were lower than those in the traditional group(P<0.05);the incidence of complications in the laparoscopic group was 2.27%,which was lower than 18.18%in the traditional group(P<0.05).Conclusion:Laparoscopic repair of perforation of gastroduodenal ulcer can effectively reduce the amount of bleeding,shorten the operation time,postoperative exhaust time,time to get out of bed and hospitalization time,facilitate the early recovery of gastrointestinal function,and provide assistance for the repair of its intestinal mucosal barrier,which is of great significance to the optimization of immune function,can reduce the risk of complications,and has definite application value.