探讨腹腔镜下肝圆韧带与大网膜修补术在上消化道穿孔手术中的临床应用效果

Exploring the Clinical Application Effect of Laparoscopic Ligamenta Teres Hepatis and Greater Omentum Repair in Upper Gastrointestinal Perforation Surgery

目的 探讨腹腔镜下肝圆韧带与大网膜修复术在上消化道穿孔手术治疗中的临床应用效果。方法 回顾性选取2020年1月—2022年12月泉州市泉港区医院收治的70例上消化道穿孔患者的临床资料,按照患者治疗的手术方案分组,对照组(n=30)采用开腹修补术治疗,观察组(n=40)腹腔镜下采用肝圆韧带与大网膜修复术治疗,比较两组患者手术治疗基本情况、术后疼痛程度、并发症、血清炎性因子、生活质量水平。结果 观察组切口长度等指标水平均低于对照组,差异有统计学意义(P<0.05)。观察组术后2、6、12、24 h视觉模拟评分法指标均低于对照组,差异有统计学意义(P<0.05)。观察组感染、胃肠道瘘等并发症总发生率(2.50%)低于对照组,差异有统计学意义(χ~2=7.351,P<0.05)。手术后,观察组肿瘤坏死因子-α[(35.26±5.82)ng/mL]、白介素-6[(16.80±3.15)ng/L]、C反应蛋白[(13.83±2.68)mg/L]均低于对照组,差异有统计学意义(t=7.039、10.748、16.412,P<0.05)。手术后,观察组SF-36健康调查简表中生理职能[(84.59±4.20)分]、躯体疼痛[(89.52±3.52)分]、社会职能[(88.20±3.29)分]均高于对照组,差异有统计学意义(t=4.768、9.820、8.174,P<0.05)。结论 腹腔镜下肝圆韧带与大网膜修复术在上消化道穿孔的治疗中取得满意效果,不仅可减少手术创伤,还能够缩短患者的康复时间;降低并发症的发生风险,使患者的快速恢复到正常生活中。

Objective To explore the clinical application effect of laparoscopic ligamenta teres hepatis and greater omentum repair in the surgical treatment of upper gastrointestinal perforation.Methods The clinical data of 70 patients with upper gastrointestinal perforation admitted to Quanzhou Quangang District Hospital from January 2020 to December 2022 were retrospectively selected and the patients were divided into groups according to the surgical plan of patient treatment.The control group (n=30) were treated with open abdominal repair,while the observation group (n=40) were treated with ligamenta teres hepatis and greater omentum repair under laparoscopy.The basic conditions of surgical treatment,postoperative pain level,complications,serum inflammatory factor,and quality of life level of patients in the two groups were compared.Results The levels of incision length and other indicators in the observation group were lower than those in the control group,and the differences were statistically significant (P<0.05).The indexes of visual analog scoring method in the observation group were lower than those in the control group in 2,6,12,and 24 h postoperatively,and the differences were statistically significant (P<0.05).The total complication rate of infection,gastrointestinal fistula and intestinal obstruction in the observation group 2.50%was lower than that in the control group,and the difference was statistically significant (χ~2=7.351,P<0.05).After surgery,tumor necrosis factor-α[(35.26±5.82) ng/mL],interleukin-6[(16.80±3.15) ng/L],and C-reactive protein[(13.83±2.68) mg/L]in the observation group were lower than those in the control group,and the differences were statistically significant (t=7.039,10.748,16.412,P<0.05).After surgery,the scores of physical function[(84.59±4.20) points],somatic pain[(89.52±3.52) points],and social function[(88.20±3.29) points]in SF-36 Health Survey Short Form in the observation group were higher than those in the control group,and the differences were statistically significant (t=4.768,9.820,8.174,P<0.05).Conclusion Laparoscopic ligamenta teres hepatis and greater omentum repair has achieved satisfactory results in the treatment of upper gastrointestinal perforation,which not only reduces the surgical trauma,but also shortens the patient's recovery time,reduces the risk of complications,and enables the patient's to quickly return to normal life.