胃十二指腸潰瘍急性穿孔的診斷和治療

[摘要]目的 探討胃十二指腸潰瘍急性穿孔的診斷和手術治療的療效。方法 前瞻性的將2008年4月～2011年12月收治于筆者所在醫院的63例胃十二指腸潰瘍急性穿孔患者根據臨床癥狀、腹部穿刺及X線檢查進行診斷，確診后隨機分為兩組，分別為腹腔鏡組（實驗組），30例，開腹組（對照組）33例，回顧性的對比分析兩組手術時間、術后排氣時間、住院時間、術中出血量和切口感染以及術后使用鎮痛劑例數等。 結果 腹腔鏡組在術后排氣時間、住院時間、術中出血量和切口感染以及術后使用鎮痛劑比例數中均明顯低于開腹組（P<0.01），差異有統計學意義，但手術時間腹腔鏡組明顯高于開腹組（P<0.05），差異有統計學意義。 結論 急性胃十二指腸潰瘍穿孔的修補采取腹腔鏡修補進行治療較開腹手術治療而言具有創傷小、恢復快、住院時間短等特點，是一種治療胃十二指腸潰瘍急性穿孔的理想方案。

[關鍵詞]潰瘍急性穿孔；修補術；腹腔鏡；開腹術

[中圖分類號] R656.6 [文獻標識碼] B [文章編號] 2095-0616（2012）22-199-02

Diagnosis and treatment of acute gastroduodenal ulcer perforation

DENG Xiaofeng BAI Huirong ZENG Guihua

Dexing Hospital of Jiangxi Copper Corporation，Dexing 334224，China

[Abstract] Objective To investigate the diagnosis and the efficacy of surgical treatment of acute gastroduodenal ulcer perforation. Methods Sixty-three patients with acute gastroduodenal ulcer perforation admitted to and treated in our hospital from April 2008 to December 2011 were diagnosed retrospectively according to the clinical symptoms，abdominal puncture and X-ray examinations. Then the patients were divided into the laparoscopic group （experimental group） with 30 patients and the laparotomy group （control group） with 33 patients. The operation time，postoperative exhaust time，hospital stay，amount of intraoperative bleeding，incision infection and the number of cases of postoperative analgesics use were compared and analyzed retrospectively. Results The laparoscopic group was obviously lower than the laparotomy group in the postoperative exhaust time，hospital stay，amount of intraoperative bleeding，incision infection and the number of cases of postoperative analgesics use，with statistically significant differences （P<0.01），but was obviously higher in the operation time，with statistically significant differences （P<0.05）. Conclusion For the repair of acute gastroduodenal ulcer perforation，laparoscopy has the advantages of small trauma，early recovery and short hospital stay compared to the laparotomy，thereby is an ideal solution for the treatment of acute gastroduodenal ulcer perforation.

[Key words] Acute ulcer perforation；Repair；Laparoscopy；Laparotomy

胃十二指腸潰瘍急性穿孔在臨床上發病較高，是臨床常見的急腹癥。病情發展急驟，嚴重可威脅生命。研究表明治療胃十二指腸潰瘍急性穿孔的關鍵在于早期診斷、合理手術[1]。臨床上針對潰瘍急性穿孔的治療表明約高達80%～90%的患者需要實施急診手術治療[2]。腹腔鏡手術的出現改變了傳統的開腹手術模式。本研究就腹腔鏡手術和開腹手術治療胃十二指腸潰瘍急性穿孔進行比較分析。

1 資料與方法