中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
CHINESE JOURNAL OF MINIMALLY INVASIVE SURGERY
2014年
9期
782-785
,共4页
钟锋%王金重%赖建生%陈晓明%郭永学%陈福佳%陈海明%李嘉兴%陈亚进
鐘鋒%王金重%賴建生%陳曉明%郭永學%陳福佳%陳海明%李嘉興%陳亞進
종봉%왕금중%뢰건생%진효명%곽영학%진복가%진해명%리가흥%진아진
腹腔镜%消化性溃疡%穿孔%穿孔修补%随机对照研究
腹腔鏡%消化性潰瘍%穿孔%穿孔脩補%隨機對照研究
복강경%소화성궤양%천공%천공수보%수궤대조연구
Laparoscopy%Peptic ulcer%Perforation%Repair%Randomized controlled trial
目的:探讨腹腔镜与开腹行胃十二指肠溃疡穿孔修补术的优缺点。方法2011年4月~2013年6月,将133例胃十二指肠溃疡急性穿孔患者采用抽取信封法随机分为腹腔镜组(68例)和开腹组(65例),2组年龄、性别、穿孔大小、部位和麻醉学评分等方面无显著差异(P>0.05)。对比2组手术时间、术中出血量、术后肠鸣音恢复时间、术后第1天及第3天疼痛评分及镇痛次数、术后并发症发生率和术后住院时间等指标。结果与开腹组相比,腹腔镜组术中出血少[(10.2±2.2)ml vs.(23.7±4.6)ml,t=-21.742,P=0.000],术后肠鸣音恢复早[(26.2±6.1)h vs.(39.4±8.5)h,t=-10.324,P=0.000],术后疼痛轻[第1天疼痛评分(4.1±1.1)vs.(7.6±1.7),t=-14.159,P=0.000,第3天疼痛评分(1.7±0.9)vs.(3.6±1.2),t=-10.360,P=0.000],镇痛次数少[中位数1(0~9) vs.3(0~12),Z=-7.208,P=0.000],术后切口感染发生率低[0(0%) vs.6(9.2%),P=0.012],术后住院时间短[(6.3±1.3)d vs.(8.2±2.7)d,t=-5.206,P=0.000]。2组手术时间差异无显著性( P>0.05)。随访3~6个月,2组均无再次穿孔及死亡。结论腹腔镜手术修补胃十二指肠溃疡急性穿孔安全可靠,具有疼痛轻、切口感染少、康复快、术后住院时间短等优点,是治疗良性胃十二指肠溃疡急性穿孔的理想术式。
目的:探討腹腔鏡與開腹行胃十二指腸潰瘍穿孔脩補術的優缺點。方法2011年4月~2013年6月,將133例胃十二指腸潰瘍急性穿孔患者採用抽取信封法隨機分為腹腔鏡組(68例)和開腹組(65例),2組年齡、性彆、穿孔大小、部位和痳醉學評分等方麵無顯著差異(P>0.05)。對比2組手術時間、術中齣血量、術後腸鳴音恢複時間、術後第1天及第3天疼痛評分及鎮痛次數、術後併髮癥髮生率和術後住院時間等指標。結果與開腹組相比,腹腔鏡組術中齣血少[(10.2±2.2)ml vs.(23.7±4.6)ml,t=-21.742,P=0.000],術後腸鳴音恢複早[(26.2±6.1)h vs.(39.4±8.5)h,t=-10.324,P=0.000],術後疼痛輕[第1天疼痛評分(4.1±1.1)vs.(7.6±1.7),t=-14.159,P=0.000,第3天疼痛評分(1.7±0.9)vs.(3.6±1.2),t=-10.360,P=0.000],鎮痛次數少[中位數1(0~9) vs.3(0~12),Z=-7.208,P=0.000],術後切口感染髮生率低[0(0%) vs.6(9.2%),P=0.012],術後住院時間短[(6.3±1.3)d vs.(8.2±2.7)d,t=-5.206,P=0.000]。2組手術時間差異無顯著性( P>0.05)。隨訪3~6箇月,2組均無再次穿孔及死亡。結論腹腔鏡手術脩補胃十二指腸潰瘍急性穿孔安全可靠,具有疼痛輕、切口感染少、康複快、術後住院時間短等優點,是治療良性胃十二指腸潰瘍急性穿孔的理想術式。
목적:탐토복강경여개복행위십이지장궤양천공수보술적우결점。방법2011년4월~2013년6월,장133례위십이지장궤양급성천공환자채용추취신봉법수궤분위복강경조(68례)화개복조(65례),2조년령、성별、천공대소、부위화마취학평분등방면무현저차이(P>0.05)。대비2조수술시간、술중출혈량、술후장명음회복시간、술후제1천급제3천동통평분급진통차수、술후병발증발생솔화술후주원시간등지표。결과여개복조상비,복강경조술중출혈소[(10.2±2.2)ml vs.(23.7±4.6)ml,t=-21.742,P=0.000],술후장명음회복조[(26.2±6.1)h vs.(39.4±8.5)h,t=-10.324,P=0.000],술후동통경[제1천동통평분(4.1±1.1)vs.(7.6±1.7),t=-14.159,P=0.000,제3천동통평분(1.7±0.9)vs.(3.6±1.2),t=-10.360,P=0.000],진통차수소[중위수1(0~9) vs.3(0~12),Z=-7.208,P=0.000],술후절구감염발생솔저[0(0%) vs.6(9.2%),P=0.012],술후주원시간단[(6.3±1.3)d vs.(8.2±2.7)d,t=-5.206,P=0.000]。2조수술시간차이무현저성( P>0.05)。수방3~6개월,2조균무재차천공급사망。결론복강경수술수보위십이지장궤양급성천공안전가고,구유동통경、절구감염소、강복쾌、술후주원시간단등우점,시치료량성위십이지장궤양급성천공적이상술식。
Objective To compare the differences of the results between the laparoscopic and open repair in the treatment of acute peptic ulcer perforation . Methods From April 2011 to June 2013, 133 patients with a clinical diagnosis of perforated peptic ulcer were randomly assigned to either laparoscopic (n=68) or open (n=65) repairs.The two groups were comparable in age , sex, size and site of perforations, and American Society of Anesthesiology (ASA) classification (P>0.05).The data of the operation time, operative bleeding, postoperative bowel sound recovery time , pain scores, sedative usage, incidence of complications, and length of postoperative hospital stay were compared between the two groups . Results All the laparoscopic or open repairs were completed successfully under general anesthesia .The operative bleeding and postoperative bowel sound recovery time in laparoscopic group were significantly less than those in the open group [(10.2 ±2.2) ml vs.(23.7 ±4.6) ml, t=-21.742, P=0.000 and (26.2 ±6.1) h vs.(39.4 ±8.5) h, t =-10.324, P=0.000].After surgery, patients in the laparoscopic group required significantly less parenteral analgesics than those who underwent open repair [median, 1 dose(0-9) vs.3 doses(0-12), Z=-7.208, P=0.000). The visual analog pain scores ( VAS ) in day 1 and day 3 after surgery were significantly lower in the laparoscopic group as well [(4.1 ±1.1) vs.(7.6 ±1.7), t=-14.159, P=0.000 and (1.7 ±0.9) vs.(3.6 ±1.2), t=-10.360, P=0.000].There were fewer incision infections in the laparoscopic group than those in the open group (0 vs.6 cases, P =0.012).The mean postoperative hospital stay was (6.3 ±1.3) days in the laparoscopic group versus (8.2 ±2.7) days in the open group (t=-5.206, P=0.000).Laparoscopic repair of perforated peptic ulcer took similar time with open repair (P>0.05).The patients were followedup for 3 -6 months , during which there was no patient undergoing re-perforation or fatal complications in both groups . Conclusions Laparoscopic repair of perforated peptic ulcer is a safe and reliable procedure .It is associated with less damage , less postoperative pain , less incision infections , quicker recovery , shorter postoperative hospital stay , and earlier return to normal daily activities than the conventional open repair , being an ideal treatment for most acute peptic ulcer perforation .