【摘要】 目的比较腹腔镜与开腹修补术治疗上消化道溃疡穿孔的临床效果。方法选择2009年9月至2016年8月暨南大学附属郑州市第二人民医院收治的上消化道溃疡穿孔患者78例,根据患者自愿原则分为开腹修补组(n=41)和腹腔镜修补组(n=37),开腹修补组患者行传统开腹穿孔修补术,腹腔镜修补组患者行腹腔镜穿孔修补术,比较2组患者的手术时间、术中出血量、术后排气时间、术后引流量、术后住院时间及并发症发生率。结果 2组患者均顺利完成手术,腹腔镜修补组无中转开腹手术患者。腹腔镜修补组患者手术时间、术后排气时间及住院时间显著短于开腹修补组(P<0.05),术中出血量、术后引流量显著少于开腹修补组(P<0.05)。腹腔镜修补组发生肠梗阻2例,腹腔脓肿1例,并发症发生率为8.1%(3/37);开腹修补组发生切口感染4例,肠梗阻5例,腹腔脓肿3例,并发症发生率为29.3%(12/41);腹腔镜修补组患者并发症发生率显著低于开腹修补组(χ~2=4.217,P<0.05)。肠梗阻患者经禁食、营养支持等对症处理5 d后恢复肠道功能,腹腔脓肿患者经B超引导下穿刺等对症处理治疗10 d后脓肿消失,切口感染患者经抗感染治疗后治愈。结论腹腔镜上消化道溃疡穿孔修补术具有创伤小、手术时间短、出血少、术后患者恢复快、并发症少等优点。更多还原

【Abstract】 Objective To compare the clinical effect between laparoscopic and open repair for upper gastrointestinal ulcer perforation. Methods A total of 78 patients with upper gastrointestinal ulcer perforation were selected from September2009 to August 2016 in the Second People’s Hospital of Zhengzhou City Affiliated to Jinan University. The patients were divided into open repair group( n = 41) and laparoscopic repair group( n = 37) according to the voluntary principle. The patients in the open repair group were treated with traditional open repair of perforation,and the patients in the laparoscopic repair group were treated with laparoscopic repair of perforation. The operation time,intraoperative bleeding volume,postoperative anal exhaust time,postoperative draining volume,postoperative hospitalization time and incidence of complications were compared between the two groups. Results The operations of the patients in the two groups were successfully completed,no patient was converted to open repair in laparoscopic repair group. The operation time,postoperative anal exhaust time and hospitalization time in the laparoscopic repair group were significantly shorter than those in the open repair group( P < 0. 05),the intraoperative bleeding volume and postoperative draining volume in the laparoscopic repair group were significantly less than those in the open repair group( P < 0. 05). There were two cases of intestinal obstruction and one case of abdominal abscess in laparoscopic repair group,the complication rate was 8. 1%( 3/37). There were four cases of incision infection,five cases of intestinal obstruction and three cases of abdominal abscess in the open repair group,the complication rate was 29. 3%( 12/41). The complication rate in the laparoscopic repair group was significantly lower than that in the open repair group( χ~2= 4. 217,P <0. 05). The intestinal function of the patients with intestinal obstruction recovered after fasting,nutritional support and other symptomatic treatment for five days. Ten days after punctures by B-mode ultrasonic guidance,the abscesses in the patients with abdominal abscess disappeared. The patients with incision infection cured after anti infective therapy. Conclusion Laparoscopic repair for upper gastrointestinal ulcer perforation has the advantages of less trauma,shorter operation time,less bleeding,faster postoperative recovery,fewer complications,and so on.更多还原