腹腔镜十二指肠溃疡穿孔修补术操作技巧探讨

腹腔镜十二指肠球部溃疡穿孔修补术的手术操作方法较多。从1998年以来我们共施行腹腔镜十二指肠球部溃疡穿孔修补术33例,现结合体会总结如下。     

腹腔镜与传统开腹手术治疗十二指肠球部溃疡穿孔的对照研究

目的：旨在比较腹腔镜修补与开腹手术对十二指肠球部溃疡穿孔的治疗效果。方法：收集我院1996年2月至1999年2月间用腹腔镜行十二指肠球部溃疡穿孔孔修补术的15例临床资料,并将其与同期内行开腹修补穿孔和胃大部切除治疗该病的各15例病例进行对照研究。结果：腹腔镜组与开腹手术（开腹修补组和胃大部切除组）手术时间分别为59min,84min和204min,术后使用镇痛药者在三组中分别为7％（1／15）、73％（11／15）和80％（12／15）;术后胃肠功能恢复时间平均为25h,56h和72h;平均住院时间为6d,8d和10d。腹腔镜组、开腹手术修补组和胃大部分除组的各项指标间比较差异有非常显著性（P＜0．01或P＜0．001）。对腹腔镜组中11例患者进行了随访,平均随访时间为10个月（3－20个月）,经消化道钡餐X线检查和胃镜检查均未见溃疡复发。结论：用腹腔镜行十二指肠球部溃疡穿孔修补是安全,有效的治疗方法,与传统开腹手术相比具有手术时间短,损伤小,切口疼痛轻,术后恢复快, 住院时间短等优点。     

十二指肠溃疡穿孔的腹腔镜外科处理

目的：探讨应用腹腔镜技术对十二指肠溃疡穿孔诊治的效果。方法：1995年以来对25例十二指肠溃疡穿孔并发弥漫性腹膜炎患者采用腹腔镜检查明确诊断，并在镜下行穿孔缝合及大网膜覆盖修补术，其中6例同时行壁细胞迷走神经切断术(PCV)，术后留置腹腔引流，并用H2受体拮抗剂、质子泵抑制剂或联用抗幽门螺杆菌治疗。结果：25例患者全部在腹腔镜下完成手术，无手术并发症，平均手术时间55min，平均住院时间6d，术后随访6～36个月，无溃疡复发。结论：腹腔镜技术应用于十二指肠溃疡穿孔的治疗，创伤小、痛苦少、并发症低，而且能够获得与开腹手术同样的临床疗效。     

胃十二指肠溃疡急性穿孔患者腹腔镜下修补术后联合三联疗法治疗的临床疗效

目的探讨幽门螺杆菌(H.pylori)相关性胃十二指肠溃疡急性穿孔患者应用腹腔镜下修补术后联合三联疗法治疗的临床疗效。方法选取2012年1月至2015年1月于广州中医药大学第一附属医院二外科行腹腔镜下修补术治疗的120例H.pylori相关性胃十二指肠溃疡急性穿孔患者为研究对象,根据术后治疗方法的不同分为对照组与观察组,每组60例。两组术后均给予常规治疗,观察组在常规治疗的基础上增加三联疗法(奥美拉唑+克拉霉素+甲硝唑),观察手术治疗效果,比较两组H.pylori根除率、临床症状评分与复发率。结果两组手术均成功,两组手术时间均在50~100 min,术后无幽门梗阻、无肠瘘、出血等并发症发生。观察组H.pylori根除率为96.67%,明显高于对照组的78.33%(P0.05);观察组治疗后6周临床症状评分低于对照组;随访期间观察组复发率为1.67%,低于对照组的11.67%(P0.05)。结论采用腹腔镜下修补术治疗H.pylori(+)胃十二指肠溃疡急性穿孔患者,安全可靠;术后给予患者药物三联疗法治疗可有效根除H.pylori,促进患者胃肠功能的恢复,降低复发率。     

肝紫斑病尸检一例报告

1病例简介患者,男,47岁。2005年4月5日17时,因“十二指肠球部溃疡穿孔,泛发性腹膜炎”,入住肇东市人民医院,于21时10分行“胃大部切除术毕Ⅱ式吻合术”治疗。术后支持治疗,患者状态平稳。既往有十二指肠球部溃疡,并于2004年7月穿孔行“十二指肠球部溃疡穿孔修补术”。患者于4月     

传统开腹与腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔临床疗效对比分析

目的:分析对比传统开腹与腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔临床疗效。方法:选取84例胃十二指肠溃疡穿孔患者分为观察组和对照组,分别给予传统开腹修补和腹腔镜穿孔修补,比较两组患者手术情况,术后恢复情况、住院时间/费用及并发症发生率。结果:两组患者住院费用和溃疡愈合率,差异无统计学意义(P>0.05),观察组患者手术切口、手术时间、术中出血量、术后肛门排气时间、胃肠功能恢复时间、术后下床活动时间及并发症发生率显著低于对照组,差异均有统计学意义(P<0.05)。结论:腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔创伤小、出血量少、缩短患者术后恢复时间,降低并发症的发病率,溃疡与愈合率与开腹手术无异,值得进一步推广应用。     

腹腔镜与开腹胃十二指肠溃疡穿孔修补术的对比研究

选择胃十二指肠溃疡穿孔修补患者68例,对其中32例采用腹腔镜治疗(腹腔镜组),36例行开腹穿孔修补术(开腹组),术后正规抗溃疡治疗.发现与开腹组比较,腹腔镜组手术时间明显缩短,术中出血量减少,术后肠蠕动恢复时间及下床活动时间较早,术后镇痛例数减少.认为腹腔镜胃十二指肠溃疡穿孔修补术具有创伤小、康复快、住院时间短等优点,术后抗溃疡治疗效果满意,值得临床推广.     

肝硬化并发上消化道溃疡穿孔患者手术治疗方式及疗效

目的探讨肝硬化并发上消化道溃疡穿孔患者的手术治疗方式及疗效。方法回顾性分析2009年6月至2019年6月于首都医科大学附属北京地坛医院进行手术治疗的46例肝硬化并发上消化道溃疡穿孔患者的临床资料。其中40例行穿孔修补术,6例行远端胃大部切除术。依据手术方式不同,将穿孔修补术患者分为开腹组(18例)和腹腔镜组(22例),比较两组患者手术时间、术中出血量、术后排气时间、术后住院时间及术后并发症。电话或门诊随访行穿孔修补术患者术后1～12个月胃镜结果。结果开腹组与腹腔镜组患者手术时间[(131.3±21.7)min vs(85.7±22.8)min]、术中出血量[(150.0±40.8)ml vs(40.0±11.5)ml]、术后排气时间[(4.5±1.3)d vs(2.8±1.0)d]、术后住院时间[(28.1±20.7)d vs(8.1±1.8)d]及术后并发症[61.1%(11/18)vs 22.7%(5/22)]差异均有统计学意义(P均0.05)。行远端胃大部切除术的6例患者均无严重并发症。随访40例穿孔修补术后患者,29例在术后1～12个月进行了胃镜检查,其中3例溃疡未愈合,继续内科治疗后痊愈;3例十二指肠球部瘢痕伴狭窄,患者无症状;1例胃窦溃疡患者术后1年复查溃疡癌变。结论腹腔镜穿孔修补术更适用于肝硬化并发上消化道溃疡穿孔患者,具有创伤小、手术时间短、出血量少及恢复快等优点。远端胃大部切除术可综合患者情况谨慎开展。     

应用腹腔镜治疗外科急腹症150例报告

本文报告应用腹腔镜技术治疗外科急腹症１５０例，其中９２例急性胆囊炎完成腹腔镜下胆囊切除术８１例，５０例急性阑尾炎完成腹腔镜下阑尾切除术４４例，胃、十二指肠球部溃疡穿孔腹腔镜修补５例，脾破裂、粘连性肠梗阻、原发性腹膜炎各１例腹腔镜手术均获成功。完成腹腔镜手术者术后恢复快，并发症少，取得了较满意的效果，本文介绍了腹腔镜治疗多种急腹症的操作要点及技巧，并提出急腹症行急诊腹腔镜探查的指征。     

腹腔镜治疗急性胃十二指肠溃疡穿孔的疗效观察

目的探讨腹腔镜治疗急性胃十二指肠溃疡穿孔的疗效。方法选取我院2013年1月~2015年1月收治的急性胃十二指肠溃疡穿孔患者50例为研究对象,随机分为对照组和观察组,对照组方法进行传统手术方式治疗,观察组给予腹腔镜治疗,对比两组患者术中出血量、术后并发症发生率、术后肛门排气时间及住院时间。结果观察组患者的术中出血量、术后并发症发生率、术后肛门排气时间及住院时间均明显优于对照组,差异有统计学意义(P0.05)。结论腹腔镜治疗急性胃十二指肠溃疡穿孔疗效显著。     

Perforated peptic ulcer in Hong Kong and New South Wales

Direct comparisons of ulcer perforation rates and trends between countries have not been made in the past. Data on hospital admissions for perforated peptic ulcer during 1 January 1979 to 31 December 1985 were collected in Hong Kong (5868 perforations) and New South Wales, Australia (1669 perforations). Age and sex specific rates per 100,000 population were calculated. In Hong Kong, annual duodenal ulcer and gastric ulcer perforation rates were 13-16 and under two per 100,000 population respectively. In New South Wales, the corresponding rates were between three and four and under two per 100,000 population, respectively. The male:female ratios for duodenal ulcer perforation were consistently about 5:1 in Hong Kong and 2:1 in New South Wales, and for gastric ulcer perforation about 2:1 and 1:1, respectively. The incidence of perforation increased with age, and there was a statistically significant rise, over time, in duodenal but not gastric ulcer perforation rates in persons aged over 60 years in New South Wales; similar trends were seen in Hong Kong. Thus duodenal ulcer perforation occurs five times more commonly in Hong Kong than in New South Wales and this is largely accountable for by the higher rates of duodenal ulcer perforation in Chinese than in Australian males. Such geographical differences can best be explained by the occurrence of multiple aetiological mechanisms in ulcer perforation. Furthermore, there appears to be an increased susceptibility and an appreciable rising trend for duodenal ulcer perforation to occur in the elderly.     

Observations on peptic ulcer in Shan Dong, China

The study consisted of 10 994 inpatients with peptic ulcer in Shan Dong province. The ratio of duodenal to gastric ulcer was 1.59 : 1. The ratio of males to females was 6.8 : 1 for duodenal ulcer and 4.6 : 1 for gastric ulcer. The highest incidence was in adolescence and young adults and the presentation occurred more commonly in winter. A study of blood groups revealed that there was no relationship between blood group and duodenal or gastric ulcer. The majority (71.9%) of patients with peptic ulcer had complications of upper gastrointestinal bleeding, perforation or gastric outlet obstruction. Bleeding and obstruction were equally common in gastric and duodenal ulcer, but perforation was more common in gastric ulcer.     

经内镜钛夹封闭治疗胃、十二指肠急性穿孔

目的 探讨经内镜钛夹封闭对胃、十二指肠急性穿孔治疗的价值。方法 对22例消化性溃疡导致或内镜诊治时出现的胃、十二指肠急性穿孔患者进行内镜下钛夹封闭治疗。结果 内镜下钛夹封闭成功19例(86．4％)，其中一次封闭成功14例(73．7％)，24h后内镜复查补充封闭5例(26．3％)。封闭失败转外科手术治疗3例。内镜下钛夹封闭效果与胃、十二指肠穿孔部位、原因及大小有关。结论 内镜下钛夹封闭是治疗消化性溃疡导致或内镜诊治出现的胃、十二指肠急性穿孔的有效方法。     

Laparoscopic management of duodenal ulcer perforation: is it advantageous?

BACKGROUND: Surgery is the mainstay of treatment of patients with peptic duodenal perforation. With the advent of minimal access techniques, laparoscopy is being used for the treatment of this condition. METHODS: Retrospective analysis of 120 consecutive patients (mean age 44.5 years; 111 men) with duodenal ulcer perforation who had undergone laparoscopic surgery. RESULTS: 87 patients had history of tobacco consumption, 12 were chronic NSAID users, 72 had Helicobacter pylori infection and 36 had a co-morbid condition. The mean time to surgery from onset of symptoms was 28.4 hours. The median operating time was 46 minutes. All patients underwent laparoscopic closure of the perforation with Graham's patch omentopexy; 12 patients underwent additional definitive ulcer surgery. The morbidity rate was 7.5%; no patient needed conversion to open surgery or died. The mean postoperative hospital stay was 5.8 days. CONCLUSION: Results of laparoscopic management of perforated peptic ulcer are encouraging, with no conversion to open surgery, low morbidity and no mortality.     

CASE REPORT OF TRICHOBEZOAR CAUSING GASTRIC PERFORATION

A 17‐year‐old girl with trichophagia (hair eating) habits was admitted to our hospital because of severe acute epigastralgia in June 1997. Abdominal computed tomography showed free air in the abdominal cavity and a heterogeneous mass in the stomach and the duodenum. A perforation on the anterior wall of the lower gastric body was found by urgent laparoscopic surgery and thus a laparoscopic omental patch repair was performed. Endoscopic examination after the operation revealed a large trichobezoar and gastric ulcers. An attempt made by us to extract the bezoar by endoscopy using a flexible outer‐tube was unsuccessful. The gastric ulcer relapsed in November 1997. Another attempt was made to extract the bezoar with laparoscopic instrumentation using a percutaneous gastrostomy port associated with oral gastroendoscopy. Only the part of the bezoar in the duodenum was extracted, and multiple superficial ulcers and erosions in the second part of the duodenum were found. Removal of the entire bezoar in the stomach required surgical gastrostomy. An endoscopic examination after the operation revealed healing of the gastric ulcer and duodenal erosions. Gastric perforation due to trichobezoar is a rare complication. Since the attempt to remove the trichobezoar in a minimally invasive manner failed, a surgical gastrostomy was required.     

Laparoscopic versus open surgical closure of perforated duodenal ulcers: a comparative study.

BACKGROUND: Laparoscopic closure of duodenal ulcer perforation may be an alternative to open surgery due to lower morbidity. Most published series have used omental plug for laparoscopic closure. We performed simple closure of the perforation laparoscopically and compared the results with those obtained by open surgery. METHODS: Of 77 consecutive patients with duodenal ulcer perforation 10 were excluded due to their high risk for laparoscopic surgery. 34 (age 18-61 years; one woman) were treated by laparoscopic surgery while 33 (age 23-63 years; two women) underwent laparotomy. Closure of the perforation was achieved by suturing the edges of the perforation. RESULTS: 27 patients had successful closure of perforation by laparoscopy; one had sealed perforation and did not need closure. Conversion to open surgery was necessary in 6 patients (17.8%). Median operating time was 50 minutes (range 25 to 120) and median hospital stay was 4 days (range 4 to 6) for laparoscopy. There was no postoperative leak. Corresponding figures for open surgery were 55 minutes (45 to 75) and 9 days (7 to 13). Patients in the laparoscopy group returned early to work (median 13 days, range 10 to 15 days postoperatively) as against 26 days (21 to 35) in the open surgery group (p < 0.001). CONCLUSION: Laparoscopic closure of duodenal ulcer perforation is safe and effective. It is a better method of treating duodenal ulcer perforation when the patient's condition allows pneumoperitoneum and laparoscopy.     

Antibody to herpes simplex virus type 1 in peptic ulcer patients

It has been postulated that herpes simplex virus type 1 may be a causative factor of duodenal ulcer. Serum antibody titres to herpes simplex virus type 1 in duodenal and gastric ulcer patients were compared with race-, sex- and age-matched controls. No differences in antibody titres could be demonstrated between duodenal ulcer and gastric ulcer patients and their respective controls, between gastric ulcer and duodenal ulcer patients or between acute and convalescent sera in either gastric or duodenal ulcer. Although Chinese are more susceptible to ulcer disease than Malays and Indians, antibody titres were comparable between subjects of different races. The results of this study do not support a causal role for herpes simplex virus in peptic ulcer disease.     

上消化道溃疡急性穿孔96例保守治疗的体会

目的总结上消化道溃疡急性穿孔保守治疗的体会。方法对2008-01～2009-12接受保守治疗的上消化道溃疡急性穿孔患者96例的临床资料进行回顾性分析。结果全组96例上消化道溃疡急性穿孔患者全部治愈,无出现腹腔脓肿、再穿孔和死亡病例。随访半年,预后良好84例,复发10例,死亡2例。结论对于上消化道溃疡急性穿孔的治疗,在严格掌握适应证的前提下对患者采取保守治疗,可以取得满意效果。     

Synchronous spontaneous perforation of the esophagus and a duodenal ulcer

SUMMARY: Although 41% of patients with spontaneous rupture of the esophagus also suffer from gastro duodenal ulcer disease, cases of synchronous spontaneous esophageal and duodenal ulcer perforation have thus far not been reported in the literature. We report on the case of a 61-year-old man who presented with a 72-hour history of esophageal rupture and duodenal ulcer perforation. Following appropriate circulatory resuscitation we performed double resection; involving the esophagus, cardia and the distal part of the stomach, followed by substitution by means of gastro-jejunal transposition as a one-stage procedure. With reference to this case with a favorable outcome, we are presenting an analysis of indications for resectional surgery in advanced spontaneous esophageal perforation.