腹腔镜手术治疗老年上消化道穿孔的疗效分析

目的探讨腹腔镜手术治疗老年上消化道穿孔的疗效。方法回顾性分析2017年1月～2018年12月福建省立医院收治的老年上消化道穿孔修补术患者70例,其中35例腹腔镜手术者为腹腔镜组,35例开放手术者为开放组,比较两组手术时间、术中出血量、术中合并脏器损伤情况、术后首次下床时间、胃肠功能恢复时间、住院时间、镇痛药使用情况以及术后并发症之间的差异。结果腹腔镜组在手术时间、术中出血量、术中合并脏器损伤方面与开放组均无明显差异,而在术后首次下床时间、胃肠功能恢复时间、住院天数及术后镇痛药物使用次数方面均显著优于开放组,差异具有统计学意义(P0.05)。术后并发症方面腹腔镜组切口感染率(1例,2.86%)明显低于开放组(7例,20.00%),差异具有统计学意义(P0.05),而其他并发症包括肺部感染、肠梗阻、腹腔积液(感染)等方面,两组相比差异无统计学意义。结论腹腔镜上消化道穿孔修补术应用于老年患者,不增加手术时间及围手术期并发症,同时具有创伤小、术后疼痛少、恢复快等优点,疗效好,应优先选择。

Analysis of efficacy of laparoscopic surgery in elderly patients with upper gastrointestinal tract perforation

Objective To explore the efficacy of laparoscopic surgery in elderly patients with upper gastrointestinal tract perforation.Methods Retrospective analysis of 70 elderly patients with upper gastrointestinal tract perforation repair treated in Fujian Provincial Hospital from January 2017 to December 2018 was conducted,among which 35 patients with laparoscopic surgery were included in the laparoscope group and 35 patients with open surgery were included in the open group.The operation time,intraoperative blood loss,intraoperative visceral organ injury,postoperative first time of getting out of bed,recovery time of gastrointestinal function,hospital stay,using of analgesics and postoperative complications in the two groups were compared.Results There was no significant difference in the operation time,intraoperative blood loss and intraoperative visceral organ injury between the laparoscope group and the open group,whereas the postoperative first time of getting out of bed,recovery time of gastrointestinal function,hospital stay and using of analgesics in the laparoscope group were all better than those in the open group,with statistically significant differences(P<0.05).In terms of postoperative complications,the infection rate of incision in the laparoscope group(1 patient,2.86%) was significantly lower than that in the open group(7 patients,20.00%),with statistically significant differences(P<0.05),whereas there was no statistically significant difference in other complications including pulmonary infection,intestinal obstruction,abdominal effusion (infection) between the two groups.Conclusion Laparoscopic upper gastrointestinal tract perforation repair applied in the elderly patients will not increase the operation time and perioperative complications,and has the advantages of small trauma,less postoperative pain,rapid recovery and good efficacy,which should be a priority.