腹腔镜手术、开腹手术及保守治疗胃十二指肠溃疡穿孔的对比研究

目的:探讨腹腔镜手术、开腹手术及保守治疗胃十二指肠溃疡穿孔的特点与临床疗效。方法:回顾分析2005年1月至2012年12月237例胃十二指肠溃疡穿孔患者的临床资料,其中56例行腹腔镜手术,147例行传统开腹手术,34例采用非手术治疗,对比3组患者全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)症状改善时间、手术时间、肠蠕动恢复时间、并发症、住院时间、住院花费等指标。结果:腹腔镜组在SIRS症状改善时间、肠蠕动恢复时间、腹腔脓肿与胸腔积液例数、住院时间方面明显优于非手术组与开腹手术组(P<0.05);术中出血量、切口感染例数、术后镇痛次数、术后粘连性肠梗阻发生例数明显少于开腹手术组(P<0.05);手术时间与开腹手术组相比差异无统计学意义(P>0.05);3组患者住院花费差异无统计学意义(P>0.05)。结论:腹腔镜胃十二指肠溃疡穿孔修补术具有患者创伤小、并发症少、疗效显著等优点,体现了微创手术的优越性,是目前治疗胃十二指肠溃疡穿孔的理想方法。

Comparative study on laparoscopic operation, open operation and conservative treatment for gastroduodenai ulcer perforation

Objective：To investigate characteristics and curative effect of laparoscopic and traditional operation and conserva- tive treatment on gastroduodenal ulcer perforation. Methods：Retrospective analysis was made on clinical data of 237 patients with gas- troduodenal ulcer perforation from Jan. 2005 to Dec. 2012,56 cases underwent laparoscopic operation, 147 cases underwent traditional open operation,34 cases underwent conservative treatment, following factors were compared among the 3 groups： improvement time of SIRS symptoms, surgical time, intestinal peristalsis recovery time, complications, hospital stay, hospital costs. Results ： Laparoscopic op- eration group is superior to traditional operation and conservative treatment group in improvement time of SIRS symptoms, bowel peri- stalsis recovery time, abdominal abscess and pleural effusion, hospital stay （ P 〈 O. 05 ）. The intraoperative blood loss, incision infection, postoperative analgesia,postoperative adhesive intestinal obstruction in the laparoscopic group were markedly less than those in tradi- tional open surgery group （ P 〈 0.05 ）. There was no significant difference in operation time between laparoscopic group and open group （ P 〉 0.05 ）, three groups had no significant differences in hospitalization cost （ P 〉 0.05 ）. Conclusions ： Laparoscopic operation has so many advantages in treating gastroduodenal ulcer perforation, such as small trauma, few complications, distinct effect, which reveals the minimally invasive superiority, so it is the best way to treat gastroduodenal ulcer perforation.