单向倒刺缝线在腹腔镜胃十二指肠巨大溃疡穿孔修补术的使用经验

目的探讨单向倒刺缝线在穿孔直径≧1.0 cm的胃十二指肠溃疡穿孔病例腹腔镜下修补的安全性与疗效。方法回顾性分析我院胃肠外科2014年2月~2017年6月采用单向倒刺缝线行腹腔镜胃十二指肠巨大溃疡穿孔修补术的32例病例,采用单向倒刺缝线对穿孔部位进行连续全层缝合,统计分析所有病例的手术时间、术中出血量、术后肛门排气时间、住院时间及并发症发生情况。结果 32例病例均成功完成手术,无中转开腹病例,围手术期无并发症发生。其中十二指肠球部前壁溃疡穿孔的有24例,胃窦前壁溃疡穿孔的有8例,穿孔部位直径≧1.0 cm且1.5 cm的病例有18例,≧1.5 cm且2.0 cm的有10例,≧2.0 cm的有4例。全组手术时间43.06±5.29 min,术中出血量9.25±3.47 m L,术后肛门排气时间34.31±7.85 h,住院时间7.53±1.02 d。结论在腹腔镜下将倒刺缝线应用于修补穿孔直径≧1.0 cm胃十二指肠溃疡穿孔病例是安全有效的,既有利于患者的恢复,同时也降低了腹腔镜下缝合难度。

Application of unidirectional barbed suture in laparoscopic repair of gastroduodenal huge ulcer perforation

［Abstract］ Objective To explore the safety and effectivity of unidirectional barbed suture for laparoscopic repair of the gastroduodenal ulcer perforation cases with the diameter of perforation greater than or equal to 1.0 cm. Methods From February 2014 to June 2017, 32 cases with gastroduodenal huge ulcer perforation who underwent laparoscopic repair by using unidirectional barbed suture were retrospectively reviewed, and the ulcer perforation was closed with a way of unidirectional barbed suture of full?thickness. The duration of surgery , intraoperative blood loss, flatus time after operation, hospital stay and complications were collected and analyzed. Results All of 32 cases underwent successful operations without conversion to open surgery and without perioperative complications. There were 24 cases with anterior wall of duodenal bulb ulcer perforation , and 8 cases with gastric antrum mastoideum ulcer perforation. There were 18 cases with the diameter of perforation greater than or equal to 1.0 cm and less than 1.5 cm, 10 with the diameter of perforation greater than or equal to 1.5 cm and less than 2.0 cm, and 4 with the diameter of perforation greater than or equal to 2.0 cm. The average operation duration was 43.06 ± 5.29 min. The intra?operative blood loss was 9.25 ± 3.47 ml. The flatus time after operation was 34.31 ± 7.85 h The hospital stay was 7.53 ± 1.02 d. Conclusion It is safe and effective to perform laparoscopic repair for the gastroduodenal ulcer perforation patients with the diameter of perforation greater than or equal to 1.0 cm by using unidirectional barbed suture, which This method reduces the difficulty of laparoscopic suture and beneficial to the recovery of patients.