腹腔镜与开腹手术治疗１２４例消化性溃疡急性穿孔的对比研究.DOCVIP

临床医学论文-腹腔镜与开腹手术治疗１２４例消化性溃疡急性穿孔的对比研究 ????????? 作者：许建平，范德标，林海军，董方林 【摘要】? 目的：对比分析腹腔镜下与开腹修补消化性溃疡急性穿孔的手术疗效。方法：２００２年１月至２００４年１２月急诊行消化性溃疡穿孔修补术１２４例，于腹腔镜下完成６５例，传统开腹完成５９例，比较两种手术患者的年龄、手术时间、术后下床活动时间、术后排气时间、术后止痛药使用率、术后并发症发生率、住院时间、综合住院费用、药品比例等。结果：２组除患者年龄、性别、白细胞计数及中性粒细胞百分比、手术时间、综合住院费用外，余者差异均有显著性(P0.05)。结论：腔镜手术修补具有创伤小、康复快、并发症少、住院时间短、美容效果好、医疗效率高等优点，是治疗消化性溃疡急性穿孔较理想的手术方式。 　　【关键词】? 消化性溃疡；急性穿孔；腹腔镜；穿孔修补术 　　Contrastive study on 124 cases with acute perforation of digestive ulcer treated with laparoscopy or laparotomy 　　【Abstract】? Ｏbjective:To contrast the effect of laparoscopy and laparotomy for acute perforation of digestive ulcer.Methods:124 cases with acute perforation of digestive ulcer performed repaired operation were analysized,65 cases treated by laparoscopy,59 cases treated by laparotomy.Two methods were contrasted in patients age,operative time the time of leaving bed to move after operation,discharge gas time after operation,rate of using anodyne after operation take place complication rate postoperation,hospitalization,all fees in hospital ,drugs proportion.Results:All indexes were different signifioantly.between laporoscopy and laparotomy except for patientsyage,sex,leucocyte enumerate and neutrophilic granulocyte percent,hospitalization,all fees in hospital(P0.05).Conclusions: Repair by laparoscopy has many advantages:less invasive,rapid recovery,less complication,short time in hospital,better aesthetic,great effective rate.So laparoscope operation is an idea method to treat digestive ulcer acute perforation.??? 【Key words】? Digestive ulcer;Acute perforation;Laparoscopy; Repair operation ??? 消化性溃疡急性穿孔过去的治疗方法多采用传统开腹手术，随着微创理念的普及和腹腔镜外科手术设备的提高和手术经验的不断积累，越来越多的临床医师喜欢采用腹腔镜穿孔修补术。2002年1月至2004年12月我院采用腹腔镜下或传统开腹行穿孔修补术１２４例，其中腹腔镜下溃疡穿孔修补术65例，传统开腹穿孔修补术59例，现将疗效比较报道如下。 　　1? 资料与方法 　　1.1? 临床资料? 　　本组消化性溃疡急性穿孔１２４例，术前向患者说明所要施行手术的必要性，手术特点，可能出现的危险、并发症、后遗症，手术大约费用，根据患者的意愿分为腹腔镜组65例，开腹组59例。 　　1.2? 手术方法 　　腹腔镜组：采用气管插管全麻，在脐下作１０mm弧形切口建立气腹，气腹压力１２～１４mm Hg，然后插入１０mm 0°腹腔镜，患者取头高足低１５°～３０°位，直视下在剑突下放置１０mm Troc