腹腔镜胃溃疡穿孔修补术在胃溃疡合并穿孔中的应用效果

Application Effect of Laparoscopic Repair of Gastric Ulcer Perforation in Gastric Ulcer Combined with Perforation

目的:探讨腹腔镜胃溃疡穿孔修补术在胃溃疡合并穿孔中的应用效果。方法:选取2020年1月-2021年12月钟祥市中医院诊治的80例胃溃疡合并穿孔患者,采用随机数表法将其分为试验组和对照组,各40例。对照组接受传统穿孔修补术治疗,观察组接受腹腔镜胃溃疡穿孔修补术治疗。比较两组手术相关指标、胃肠动力恢复情况、血清胃泌素水平、免疫功能指标及并发症发生率。结果:观察组手术时间、手术切口长度、术后下床活动时间、引流管拔除时间、术后住院时间、肠鸣音恢复时间、肛门排气时间及胃肠减压解除时间均优于对照组,术中出血量低于对照组,差异有统计学意义(P<0.05)。术前及术后1 h,两组血清胃泌素水平比较,差异无统计学意义(P>0.05);术后24 h、48 h、72 h,两组血清胃泌素水平均高于术前及术后1 h,术后48 h、72 h,两组血清胃泌素水平均高于术后24 h,术后72 h,两组血清胃泌素水平均高于术后48 h;且术后24 h、48 h、72 h,观察组血清胃泌素水平高于对照组,差异有统计学意义(P<0.05)。术前,两组CD3^(+)、CD4^(+)、CD8^(+)及自然杀伤(NK)细胞水平比较,差异无统计学意义(P>0.05);术后3 d,对照组CD3^(+)、CD4^(+)及NK细胞水平均低于术前,CD8^(+)高于术前,差异有统计学意义(P<0.05),而观察组CD3^(+)、CD4^(+)、CD8^(+)及NK细胞水平与术前比较,差异无统计学意义(P>0.05),但观察组CD3^(+)、CD4^(+)及NK细胞水平高于对照组,CD8^(+)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2.50%,低于对照组的15.00%,差异有统计学意义(P<0.05)。结论:腹腔镜胃溃疡穿孔修补术可有效促进胃溃疡合并穿孔患者的胃肠动力恢复,提高血清胃泌素水平,对机体免疫功能影响较小且术后并发症少,安全有效。

Objective:To explore the application effect of laparoscopic repair of gastric ulcer perforation in gastric ulcer combined with perforation.Method:A total of 80 patients with gastric ulcer combined with perforation treated in Zhongxiang Hospital of Traditional Chinese Medicine from January 2020 to December 2021 were selected,and they were divided into observation group and control group using the random number table method,with 40 cases in each group.The control group received traditional perforation repair,while the observation group received laparoscopic repair of gastric ulcer perforation.The operation related indexes,gastrointestinal motility recovery,serum gastrin level,immune function indexes and the incidence of complications between the two groups were compared.Result:The operation time,the length of the surgical incision,the time of getting out of bed after the operation,the time of removing the drainage tube,the time of hospitalization after the operation,the recovery time of bowel sounds,the time of anal exhaust and the time of relieving gastrointestinal decompression in the observation group were better than those in the control group,and the intraoperative blood output was lower than that in the control group,the differences were statistically significant(P<0.05).There were no significant differences in serum gastrin levels between the two groups before and 1 h after operation(P>0.05).At 24 h,48 h and 72 h after operation,the serum gastrin level in both groups were higher than those before and 1 h after operation,at 48 h and 72 h after operation,the serum gastrin level in both groups were higher than those at 24 h after operation,at 72 h after operation,the serum gastrin level in both groups were higher than those at 48 h after operation,and at 24 h,48 h and 72 h after operation,the levels of serum gastrin in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).Before operation,there were no statistically significant differences in the levels of CD3^(+),CD4^(+),CD8^(+),and natural killer(NK)cells between the two groups(P>0.05).At 3 d after operation,the levels of CD3^(+),CD4^(+),and NK cells in the control group were lower than those before operation,while the levels of CD8^(+)was higher than that before operation,the differences were statistically significant(P<0.05);however,there were no statistically significant differences in the levels of CD3^(+),CD4^(+),CD8^(+),and NK cells between the observation group before operation(P>0.05).While the levels of CD3^(+),CD4^(+),and NK cells in the observation group were higher than those in the control group,while the CD8^(+)was lower than that in the control group,the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 2.50%,which was lower than 15.00%in the control group,the difference was statistically significant(P<0.05).Conclusion:Laparoscopic repair of gastric ulcer perforation can effectively promote the recovery of gastrointestinal motility in patients with gastric ulcer combined with perforation,improve the level of serum gastrin,have less impact on the immune function of the body,and have fewer postoperative complications,which is safe and effective.