传统多孔腹腔镜与经脐单孔腹腔镜胃十二指肠溃疡穿孔修补术的疗效比较

Comparison of curative effect of traditional porous laparoscopic repair and transumbilical single-pore laparoscopic repair on perforated gastroduodenal ulcer

目的比较传统多孔腹腔镜与经脐单孔腹腔镜胃十二指肠溃疡穿孔修补术的临床效果。方法随机对照研究。抽取2020年3月至2023年3月郑州市第九人民医院收治的胃十二指肠溃疡穿孔患者84例,参照简单随机数字法分为单孔组与多孔组,每组42例。单孔组行经脐单孔腹腔镜胃十二指肠溃疡穿孔修补术,多孔组行传统多孔腹腔镜胃十二指肠溃疡穿孔修补术。比较两组围术期指标、术后疼痛情况[视觉模拟评分法(VAS)评分、术后镇痛剂使用率]、术后胃肠功能恢复情况、胃肠激素[血管活性肠肽(VIP)、胃动素(MTL)、胃泌素(GAS)]水平、肠黏膜屏障[一氧化氮(NO)、内毒素(ET)、二氧化酶(DAO)]指标及并发症发生率。结果两组手术时间、术中出血量比较差异未见统计学意义(P>0.05),但单孔组术后下床活动时间[(41.26±3.58)h]短于多孔组[(48.31±4.02)h],P<0.05。术后1、3 d,单孔组VAS评分均低于多孔组(P均<0.05);单孔组术后镇痛剂使用率(4.76%,2/42)低于多孔组(19.05%,8/42),P<0.05。单孔组肠鸣音出现时间、胃肠功能恢复时间、首次排气时间均短于多孔组(P均<0.05)。术后3 d,两组VIP、MTL及GAS水平均低于术前,但单孔组高于多孔组(P<0.05)。术后3 d,两组NO、ET、DAO水平均高于术前,但单孔组低于多孔组(P<0.05)。单孔组并发症发生率(2.38%,1/42)低于多孔组(19.05%,8/42),P<0.05。结论经脐单孔腹腔镜胃十二指肠溃疡穿孔修补术治疗胃十二指肠溃疡穿孔,可减轻对胃肠功能的刺激,加快术后胃肠功能恢复,并可减轻疼痛,降低并发症发生率。

Objective To compare the clinical effect of traditional porous laparoscopic repair and transumbilical single-pore laparoscopic repair on perforated gastroduodenal ulcer.Methods The randomized controlled study was conducted on 84 patients with perforated gastroduodenal ulcer selected from Zhengzhou Ninth People’s Hospital from March 2020 to March 2023.According to the simple random number method,the selected patients were divided into the single-hole group and the porous group,with 42 cases in each group.The single-hole group underwent transumbilical single-pore laparoscopic repair of perforated gastroduodenal ulcer,while the porous group underwent traditional porous laparoscopic repair of perforated gastroduodenal ulcer.The perioperative indicators,postoperative pain assessed by visual analogue scale(VAS)score and postoperative analgesic use rate,postoperative gastrointestinal function recovery,levels of gastrointestinal hormones,including vasoactive intestinal peptide(VIP),motilin(MTL)and gastrin(GAS),intestinal mucosal barrier indicators,including nitric oxide(NO),endotoxin(ET)and dioxygenase(DAO),and incidence of complications were compared between the two groups.Results There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).The time of getting out of bed after operation in the single-hole group was(41.26±3.58)h,which was shorter than the(48.31±4.02)h in the porous group(P<0.05).The VAS scores of the single-hole group were lower than those of the porous group 1 and 3 days after treatment(all P<0.05);the postoperative analgesic use rate in the single-hole group(4.76%,2/42)was lower than that in the porous group(19.05%,8/42),P<0.05.The appearance time of bowel sounds,gastrointestinal function recovery time,and first exhaust time in the single-hole group were shorter than those in the porous group(all P<0.05).Three days after operation,the levels of VIP,MTL and GAS in the two groups were lower than those before operation,but the levels of VIP,MTL and GAS in the single-hole group were higher than those in the porous group(P<0.05).Three days after operation,the levels of NO,ET and DAO in the two group were higher than those before operation,but the levels of NO,ET and DAO in the single-hole group were lower than those in the porous group(P<0.05).The incidence of complications of the single-hole group(2.38%,1/42)was lower than that of the porous group(19.05%,8/42),P<0.05.Conclusions Transumbilical single-pore laparoscopic repair of perforated gastroduodenal ulcer can reduce the impact on gastrointestinal function,accelerate the postoperative recovery of gastrointestinal function,relieve pain and reduce the incidence of complications.