腹腔镜胃、十二指肠穿孔修补术在基层医院的应用体会

目的:探讨基层医院行腹腔镜胃、十二指肠穿孔修补术的可行性与安全性。方法:回顾分析2009年5月至2012年12月为28例患者行腹腔镜胃、十二指肠穿孔修补术的临床资料。结果:1例(3.57%)中转开腹,27例顺利完成腹腔镜手术;手术时间60¹10 min,平均(80±10)min;术中出血量10110 min,平均(80±10)min;术中出血量10⁵0 ml,平均(20±5)ml。术后第1天即可下床活动,术后住院650 ml,平均(20±5)ml。术后第1天即可下床活动,术后住院6⁹ d,平均(7.2±0.9)d。术后随访27例患者69 d,平均(7.2±0.9)d。术后随访27例患者6¹2个月,平均(10±1.9)个月,均无并发症发生。结论:腹腔镜胃、十二指肠穿孔修补术具有患者创伤小、出血少、痛苦小、粘连少、康复快等特点,基层医院应严格把握手术适应证,适当放宽中转开腹手术指征。在具备良好的手术设备、术者具有熟练腹腔镜技术的前提下,基层开展腹腔镜胃、十二指肠穿孔修补术是安全、可行的。

Application experience of laparoscopic repair of gastroduodenal perforation at grass-roots hospitals

Objective ： To study the feasibility and safety of laparoseopic repair of gastrointestinal perforation at grass-roots hos- pitals. Methods：The clinical data of 28 patients who underwent laparoscopic repair of gastroduodenal perforation from May 2009 to Dec. 2012 were collected and retrospectively analyzed. Results：One case （3.57%） was converted to laparotomy. Laparoscopic repair of gastroduodenal perforation was successfully completed in 27 cases. The operative time was 60-110 rain, the average time was （80 ± 10） nfin;blood loss was 10-50 ml,the average blood loss was （20 ±5） ml. The patient could have a little move without staying in bed on the first day after the operation. The postoperative hospital stay was about 6-9 d, with the average of （7.2 ± 0.9） d. After the opera- tion,27 patients were followed up for 6-12 months, and the average time was （10 ± 1.9） months, and no complications were found. Conclusions ： With the eharacteristics of less trauma, blood loss, pain, adhesion and rapid recovery, laparoscopic repair of gastroduodenal perforation is a safe and feasible surgical technique under the premise of good equipments and skilled laparoseopic operating techniques at the grass-roots hospital.