腹腔镜与开腹消化性溃疡穿孔修补术比较的Meta分析

目的评价腹腔镜修补手术治疗消化性溃疡穿孔的安全性和有效性。方法收集1990－2011年公开发表的腹腔镜和开腹消化性溃疡穿孔修补术的中文和英文文献．对腹腔镜组和开腹组的术中情况、术后恢复情况及术后并发症情况进行Meta分析。结果筛选出符合纳入标准的研究19项,共1507例,腹腔镜组673例,开腹组834例。与开腹组相比,腹腔镜组患者术中出血量更少,术后排气时间更快、住院时间更短、术后切口感染率和围手术期死亡率更低（均P〈O．05）。两组患者手术时间和术后败血症、肺部感染、腹腔脓肿、修补处瘘发生率的差异则无统计学意义（均P〉O．05）。结论腹腔镜修补手术治疗消化性溃疡穿孔具有出血少、恢复快、切口感染和死亡率低的优势．安全可行。     

Laparoscopic suture closure of perforated peptic ulcer

Background: Laparoscopic vs open suture in the surgical treatment of perforated peptic ulcer were compared in a retrospective study. Methods: The outcome of 10 patients having the laparoscopic procedure was compared with the outcome of 17 patients treated with suture via laparotomy during the same time period. Results: The mortality rate and the complication rate were comparable. The laparoscopic procedure was more time consuming; hospital stay did not differ. Conclusions: The results indicate that surgery for perforated peptic ulcer can be performed with the laparoscopic technique with an outcome comparable to open surgery. No obvious advantages to the patient were noted with the laparoscopic method.This study has been presented as an abstract at the EAES meeting in Madrid, September 1994     

腹腔镜在消化性溃疡穿孔修补术中的应用

目的探讨腹腔镜修补胃十二指肠溃疡穿孔的疗效及价值。方法回顾性分析30例胃十二指肠溃疡穿孔患者实施腹腔镜修补术的临床治疗资料。结果 29例顺利完成腹腔镜手术,1例中转开腹;手术时间80~100 min,平均90 min;术后次日可下床活动;术后无需使用镇痛剂;住院天数为7~10天,平均8.5天;术后无并发症发生。结论腹腔镜修补胃十二指肠溃疡穿孔因其具有创伤小、对脏器干扰小、术后并发症少等优点,在严格把握手术适应症的前提下开展腹腔镜胃十二指肠溃疡穿孔修补术是可行的。     

腹腔镜消化性溃疡穿孔修补术23例

目的探讨腹腔镜消化性溃疡穿孔修补术的方法和治疗效果. 方法应用腹腔镜对23例消化性溃疡穿孔(十二指肠穿孔17例,胃窦部前壁穿孔5例,胃体部小弯侧穿孔1例)行穿孔修补﹑腹腔引流术. 结果手术均获成功,无手术并发症.3个月后胃镜复查,13例使用丝线者均有缝线外露,10例使用可吸收外科缝线者无缝线外露.随访6～27个月,平均18个月,3例十二指肠球部穿孔者仍有轻度嗳气,返酸,余无明显症状,无再穿孔. 结论腹腔镜消化性溃疡穿孔修补术安全可靠,术后继续正规内科治疗,效果满意.     

腹腔镜缝合修补消化性溃疡穿孔29例报告

目的:探讨腹腔镜缝合修补消化性溃疡的临床应用价值。方法:回顾分析2002~2007年我院应用腹腔镜缝合修补消化性溃疡穿孔29例患者的临床资料。结果:29例患者中胃窦部前壁穿孔9例,胃体部小弯侧穿孔7例,十二指肠球部前壁穿孔11例,2例病检诊断为癌性溃疡穿孔中转开腹。穿孔直径≤5mm 22例,>5mm 7例。27例手术成功,无术后并发症发生。手术时间和住院时间短,均痊愈出院,随访6~42个月,无复发。结论:腹腔镜缝合修补消化性溃疡治疗消化性溃疡穿孔安全可靠,是一种较理想的手术方法,术后继续正规内科治疗,效果满意。     

Laparoscopic repair of perforated duodenal ulcer

Background: A series of 100 consecutive patients with perforated peptic ulcer were prospectively evaluated in a multicenter study. The feasibility of the laparoscopic repair was evaluated. Methods: All patients had peritonitis, 20% were in septic shock, and 57% had delayed perforation. Conversion to laparotomy was necessary in eight patients. The morbidity rate was 9% and mortality rate 5%. Results: The mean delay of postoperative gastric aspiration (mean 3.4 days) and resumed food intake (mean 4.4 days) as well as the mean postoperative hospital stay (mean 9.3 days) were comparable to conventional surgery, but postoperative comfort was subjectively increased by laparoscopy and noticed by all laparoscopic surgeons participating in this study. Conclusions: Laparoscopic repair of perforated peptic ulcer proves to be technically feasable and carries an acceptable morbidity and mortality rate, compared with conventional surgery. Received: 16 August 1996/Accepted: 1 April 1997     

Laparoscopic closure of perforated duodenal ulcer

Background: Medical treatment of peptic ulcer is highly successful, and the eradication of Helicobacter pylori (H. pylori) reduces ulcer recurrence. However, the incidence of perforated duodenal ulcer and its associated mortality have not been reduced by modern methods of therapy. Laparoscopic simple closure and omental plug by suturing, fibrin glue, and stapler have been successful. Methods: Over a 1-year period (1996–97), 21 patients with perforated duodenal ulcer were operated on in our hospital by laparoscopic simple closure and omental patch. The mean age was 36.4 ± 11.8 years (range, 18–61). Twenty patients were male (93.7%). The mean duration of pain was 9.1 ± 11.7 hs (range, 2–48). Three patients had a previous history of duodenal ulcer (14.3%), and another three (14.3%) patients had a history of nonsteroidal antiinflammatory drug (NSAID) intake. Erect chest radiograph showed that 19 patients had air under the diaphragm (90.5%). Sixteen patients (76.2%) had frank pus in the abdomen, and five patients had a minimal peritoneal reaction (23.8%). Results: The mean operative time was 71.6 ± 24.6 mins (range, 40–120), and the mean hospital stay was 5.2 ± 1.6 days (range, 3–9). The mean time to resume oral fluids was 3.1 ± 0.8 days (range, 2–4). Only one patient was reoperated due to leakage identified by gastrographin swallow. Conclusions: This procedure is safe and efficient; however, further study of its long-term effectiveness and comparability to existing therapy is still needed. Received: 28 May 1998/Accepted: 17 November 1998     

腹腔镜胃十二指肠溃疡穿孔修补术28例报告

目的:探讨腹腔镜手术在胃十二指肠溃疡穿孔修补术中的应用价值。方法:2003年1月~2006年8月我院为28例胃十二指肠溃疡穿孔患者行腹腔镜穿孔修补术。结果:27例成功完成腹腔镜手术,1例中转开腹。手术时间30~100m in,平均45m in,术后住院时间5~10d,平均7.8d,术后并发症少,无一例死亡。结论:腹腔镜胃十二指肠溃疡穿孔修补术具有痛苦小,恢复快,并发症少,住院时间短等优点,疗效确切,操作简单易行,值得在临床工作中推广应用。     

腹腔镜胃十二指肠溃疡穿孔修补术

目的:探讨腹腔镜胃十二指肠溃疡穿孔修补术的临床应用及手术操作要点。方法:腹腔镜下缝合修补溃疡穿孔18例。结果:腹腔镜下缝合修补溃疡穿孔均获成功,无并发症发生。结论:腹腔镜溃疡穿孔修补术创伤小,术后并发症少,操作简单,且集诊断及治疗于一体,显示了微创外科的优越性,是目前最适合普及的治疗溃疡穿孔的腹腔镜手术方法。     

Laparoscopic repair of perforated peptic ulcer: single-center results

Background

Perforated peptic ulcer (PPU), the most common indication for emergency gastric surgery, is associated with high morbidity and mortality rates. Outcomes might be improved by performing this procedure laparoscopically, but no consensus exists on whether the benefits of laparoscopic repair (LR) of PPU outweigh the disadvantages.

Methods

From January 2002 to December 2012, 111 patients underwent surgery for perforated ulcer. A “laparoscopy-first” policy was attempted and then applied for 56 patients. The exclusion criteria for LR ruled out patients who had shock at admission, severe cardiorespiratory comorbidities, or a history of supramesocolic surgery. The aim of this study was a retrospective analysis of the 56 patients treated laparoscopically.

Results

The patient distribution was 30 men and 26 women, who had a mean age of 59 years (range 19–95 years). The mean ulcer size was 10 mm, and the Mannheim peritonitis index (MPI) was 21. LR was performed for 39 (69.6 %) of the 56 patients and included peritoneal lavage, suturing of the perforation, and omental patching. Conversion to laparotomy was necessary in 17 cases (30.4 %). The “conversion group” showed significant differences in ulcer size (larger ulcers: 1.9 vs 0.7 mm; p < 0.01), ulcer-site topography (higher incidence of posterior ulcers: 5 vs 0; p < 0.01), and MPI score (higher score: 24 vs 20; p < 0.05). The LR group had a mean operating time of 86 min (range 50–125 min), an in-hospital morbidity rate of 7.6 %, a mortality rate of 2.5 %, and a mean hospital stay of 6.7 days (range 5–12 days). None of these patients required reintervention.

Conclusions

The results showed that LR for PPU is feasible with acceptable mortality and morbidity rates. Skill in laparoscopic abdominal emergencies is required. Perforations 1.5 cm or larger, posterior duodenal ulcers, and an MPI higher than 25 should be considered the main risk factors for conversion.     

Laparoscopic repair of iatrogenic endoscopic perforated peptic ulcer

Iatrogenic perforation is an uncommon but inevitable complication of endoscopy. Laparotomy has been the standard treatment for pyloroduodenal perforations caused by endoscopy. Laparoscopic repair is a well-documented treatment modality for spontaneously perforated peptic ulcer. We report our successful laparoscopic suture repair of perforations sustained during upper gastrointestinal endoscopy in two high-risk elderly patients.     

Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial

OBJECTIVE: To compare the results of open versus laparoscopic repair for perforated peptic ulcers. SUMMARY BACKGROUND DATA: Omental patch repair with peritoneal lavage is the mainstay of treatment for perforated peptic ulcers in many institutions. Laparoscopic repair has been used to treat perforated peptic ulcers since 1990, but few randomized studies have been carried out to compare open versus laparoscopic procedures. METHODS: From January 1994 to June 1997, 130 patients with a clinical diagnosis of perforated peptic ulcer were randomly assigned to undergo either open or laparoscopic omental patch repair. Patients were excluded for a history of upper abdominal surgery, concomitant evidence of bleeding from the ulcer, or gastric outlet obstruction. Patients with clinically sealed-off perforations without signs of peritonitis or sepsis were treated without surgery. Laparoscopic repair would be converted to an open procedure for technical difficulties, nonjuxtapyloric gastric ulcers, or perforations larger than 10 mm. A Gastrografin meal was performed 48 to 72 hours after surgery to document sealing of the perforation. The primary end-point was perioperative parenteral analgesic requirement. Secondary endpoints were operative time, postoperative pain score, length of postoperative hospital stay, complications and deaths, and the date of return to normal daily activities. RESULTS: Nine patients with a surgical diagnosis other than perforated peptic ulcer were excluded; 121 patients entered the final analysis. There were 98 male and 23 female patients recruited, ages 16 to 89 years. The two groups were comparable in age, sex, site and size of perforations, and American Society of Anesthesiology classification. There were nine conversions in the laparoscopic group. After surgery, patients in the laparoscopic group required significantly less parenteral analgesics than those who underwent open repair, and the visual analog pain scores in days 1 and 3 after surgery were significantly lower in the laparoscopic group as well. Laparoscopic repair required significantly less time to complete than open repair. The median postoperative stay was 6 days in the laparoscopic group versus 7 days in the open group. There were fewer chest infections in the laparoscopic group. There were two intraabdominal collections in the laparoscopic group. One patient in the laparoscopic group and three patients in the open group died after surgery. CONCLUSIONS: Laparoscopic repair of perforated peptic ulcer is a safe and reliable procedure. It was associated with a shorter operating time, less postoperative pain, reduced chest complications, a shorter postoperative hospital stay, and earlier return to normal daily activities than the conventional open repair.     

腹腔镜行消化性溃疡急性穿孔修补手术的临床研究

目的探讨腹腔镜治疗消化性溃疡急性穿孔的临床价值。方法对腹腔镜手术组（腔镜组）53例和开腹手术组（开腹组）54例患者的手术时间、术中出血量、肠鸣音恢复时间、住院时间、使用镇痛剂例数、住院费用、术后切口及腹腔感染例数等指标进行比较。结果腔镜组术中出血量、术后肠鸣音恢复时间、住院时间、使用镇痛剂等指标均显著小于开腹组（P〈0．05）。结论腹腔镜手术具有侵袭性小、腹腔干扰小、术后痛苦小、肠功能恢复快、住院时间短等优点，可成为治疗消化性溃疡急性穿孔优先选择的治疗方法。     

腹腔镜修补术治疗胃十二指肠溃疡穿孔35例报告

目的:探讨腹腔镜修补术治疗胃十二指肠溃疡穿孔的疗效及应用价值。方法:回顾分析2007年1月至2009年12月为35例胃十二指肠球部溃疡穿孔患者行腹腔镜修补术的临床资料。结果:手术均获成功,手术时间平均80m in,术后平均4.5d进食,平均住院6d,无并发症发生。结论:腹腔镜修补术治疗胃十二指肠球部溃疡穿孔安全有效,具有患者痛苦小,损伤轻,康复快,对脏器干扰小,腹腔冲洗彻底及住院时间短等优点,值得临床推广应用。     

腹腔镜消化性溃疡穿孔修补术的临床应用

目的:探讨腹腔镜手术治疗消化性溃疡穿孔的可行性。方法:自2006年初,对上消化道溃疡穿孔患者进行前瞻性随机对照研究,按照手术方式分为开腹手术组和腹腔镜手术组,至2010年末,有效病例160例。对比分析两组患者术后疼痛指数、住院时间及术后并发症发生率。结果:腹腔镜组术后疼痛指数、住院时间低于开腹组(P<0.05),两组术后并发症发生率无明显差异,术后随访半年均无复发。结论:腹腔镜上消化道溃疡穿孔修补术是安全有效的微创术式,在一定程度上优于传统开腹手术。     

Laparoscopic repair of a perforated duodenal ulcer in two patients

(Received for publication on Dec. 20, 1996; accepted on July 8, 1997)