腹腔镜与开腹修补术治疗上消化道穿孔的比较

江滨

摘 要 目的:探讨腹腔镜与开腹修补术治疗上消化道穿孔的疗效,分析两种术式的临床价值。方法:选取60例急诊手术治疗的上消化道溃疡穿孔的患者进行回顾性分析,按术式的不同分为腹腔镜组(laparoscopy组,n=31)和开腹修补术组(laparotomy组,n=29)。结果:两组手术成功率均为100%(P>0.05)。laparoscopy组术后排气时间、进食时间、下床活动时间、住院时间均短于laparotomy组,术中出血量、术后1~3 d引流量、住院费用均少于laparotomy组,术后VAS评分、术后并发症总发生率低于laparotomy组(P<0.05)。结论:腹腔镜治疗上消化道穿孔具有术中出血及引流量少、疼痛轻、术后并发症发生率低、术后恢复快等优点。

关键词 腹腔镜 开腹修补术 上消化道穿孔

中图分类号:R656.1 文献标志码:B 文章编号:1006-1533(2021)21-0055-04

Comparison of laparoscopy and laparotomy repair in the treatment of upper gastrointestinal perforation

JIANG Bin

(Department 2 of Surgery, the Peoples Hospital of Yugan County, Shangrao 335100, China)

ABSTRACT Objective: To evaluate the efficacy of laparoscopy and laparotomy repair in the treatment of upper gastrointestinal perforation and analyze their clinical value. Methods: The data from 60 cases of patients with upper gastrointestinal perforation were retrospectively analyzed. They were divided into a laparoscopy group (n=31) and a laparotomy group (n=29). Results: Surgery were all performed in the two groups with surgery successful rate 100% (P>0.05). The times for postoperative exhaust, eating food, getting out of bed, and hospital stay were shorter, the volume of intraoperative blood loss and postoperative drainage at 1-3 days and the hospitalization costs were all less, and the postoperative VAS scores and the total incidence of postoperative complications were lower in the laparoscopy group than the laparotomy group (P<0.05). Conclusion: Laparoscopy for the treatment of upper gastrointestinal perforation has the advantages of less bleeding and drainage and less pain, low the incidence of postoperative complications and rapid postoperative recovery.

KEy wORDS laparoscopy; laparotomy; upper gastrointestinal perforation

上消化道穿孔是一种常见的外科急腹症,大多是由于消化道潰疡得不到很好的控制,尤其是胃溃疡和十二指肠溃疡,继而向深部侵蚀、穿破浆膜,穿孔,患者常表现为腹部压痛、反跳痛、肌紧张,拒绝医务人员的检查,这一类的患者需要临床及时对症处理,否则可能发展为中毒性休克,危及生命。目前,腹腔镜手术与开腹修补术是临床上常用的两种治疗方式,治疗消化道穿孔的金标准是修补穿孔、清洗腹腔并引流。随着医疗器械技术的发展,腹腔镜手术克服了开腹手术的弊处,不仅切口较小,而且视野开阔,能充分地探查腹腔,术后疼痛减轻,有利于术后恢复[1-2]。

1 资料与方法

1.1 一般资料

选取江西省余干县人民医院2018年1月—2019年6月期间60例急诊手术治疗上消化道溃疡穿孔的患者作为研究对象,按手术方式不同分为腹腔镜组(laparoscopy组,n=31)和开腹修补术组(laparotomy组,n=29)。纳入标准:患者入院时有上腹部烧灼感或疼痛等消化道临床表现,查体时可见腹部肌肉紧张,压腹时有压痛感、反跳痛,肠鸣音减弱;腹腔B超检查时可见不同程度的积液或站立位X射线检查时可见膈下有游离气体;无开腹手术或腹腔镜手术禁忌证;发病距手术时间在12 h内;患者知情同意。排除标准:有腹部手术史者;合并大出血、溃疡癌变或幽门梗阻者。两组患者的一般资料比较差异无统计学意义(P>0.05,表1),具有可比性。

标签: 腹腔镜