腹腔镜手术与开腹手术治疗胃十二指肠溃疡穿孔的疗效比较

Comparison of efficacy between laparoscopic repair surgery and laparotomy in the treatment of perforation of gastroduodenal ulcer

目的比较腹腔镜手术与开腹手术治疗胃十二指肠溃疡穿孔的疗效。方法选取2014年12月至2018年12月本院收治的123例急性胃十二指肠溃疡穿孔患者作为研究对象,按照手术方法不同分为腹腔镜组(n=73)与开腹组(n=50)。腹腔镜组行腹腔镜修补术,开腹组行开腹术,比较两组术中情况和术后并发症发生情况及镇痛剂使用率,长期随访Visick分级。结果腹腔镜组住院时间、术后肛门排气时间、手术时间均短于传统开腹组,术中出血量少于传统开腹组,差异有统计学意义(P<0.05),两组住院费用比较差异无统计学意义。腹腔镜组术后肺部感染率、切口感染率、术后镇痛使用率均低于开腹组,差异有统计学意义(P<0.05),两组术后腹腔脓肿、肠梗阻发生率比较差异无统计学意义。腹腔镜组长期随访的Visick分级优于开腹组,差异有统计学意义(P<0.05)。结论与开腹术相比,腹腔镜胃十二指肠溃疡穿孔修补术疗效显著,创伤小,患者术后恢复快,可显著缩短住院时间,减少并发症少发生,值得临床推广应用。

Objective To compare the efficacy of laparoscopic repair surgery and laparotomy in the treatment of perforated gastroduodenal ulcer.Methods 123 cases of patients with acute gastroduodenal ulcer perforation admitted to our hospital from December 2014 to December 2018 were selected as the study subjects.they were divided into the laparoscopic repair group(n=73)and the laparotomy group(n=50)according to different surgical methods.The laparoscopic repair group underwent laparoscopic repair surgery,while the laparotomy group underwent laparotomy.Intraoperative conditions,postoperative complications and analgesic use rate were compared between the two groups,and Visick classification was followed up for a long time.Results The hospitalization time,postoperative anal scheduling time,and surgical time in the laparoscopic repair group were shorter than those in the laparotomy group,and the intraoperative bleeding were less than that in the laparotomy group,the differences were statistically significant(P<0.05).There wasno statistically significant difference in hospitalization costs between the two groups.The postoperative lung infection rate,incision infection rate and postoperative analgesia use rate in the laparoscopic repair group were lower than those in the laparotomy group,the differences were statistically significant(P<0.05).There were no statistically significant differences in the incidence of postoperative abdominal abscess and Bowel obstruction between the two groups.The Visick grading in the laparoscopic repair group during long-term follow-up was better than that in the laparotomy group,the difference was statistically significant(P<0.05).Conclusion Compares with laparotomy,laparoscopic repair of perforated gastroduodenal ulcer is effectivelaparoscopic gastroduodenal ulcer perforation repair surgery has a significant therapeutic effect,minimal trauma,fast postoperative recovery,and can significantly shorten hospital stay,reduce complications,and is worthy of clinical promotion and application.