腹腔镜在困难型胃十二指肠溃疡穿孔中治疗体会.docVIP

腹腔镜在困难型胃十二指肠溃疡穿孔中治疗体会 　　[摘要] 目的 探讨腹腔镜在困难型胃十二指肠溃疡穿孔治疗中的手术技巧。 方法 回顾分析我院2007年10月～2017年4月用腹腔镜治疗的符合入选标准的28例困难型胃十二指肠溃疡穿孔的临床资料，总结治疗困难的原因及其手术策略。 结果 手术困难原因：病灶位置定位困难、穿孔修补困难。十二指肠溃疡穿孔及胃窦穿孔各10例（占71.4%），其次?槲感⊥洳啻┛缀臀负蟊诖┛祝ǜ?3例，共占21.4%）；溃疡大小主要为10～20 mm（占96.4%）。25例患者通过腹腔镜进行修补；平均手术时间（84.0±15.0）min；术后平均排气时间（26.0±12.5）h；无腹腔感染、修补口漏等并发症发生；术后平均住院时间（6.3±1.6）d。术后3个月25例均行胃镜复查，均提示溃疡愈合。 结论 困难型胃十二指肠溃疡穿孔在腹腔镜下修补，只要具备熟练的腔镜操作技术，使用恰当的操作技巧，是安全可行，不增加手术并发症，且具有腹腔镜手术的优点。 　　[关键词] 腹腔镜；困难型胃十二指肠溃疡穿孔；修补术；微创 　　[中图分类号] R656.6+1；R573.1 [文献标识码] B [文章编号] 1673-9701（2017）28-0078-04 　　[Abstract] Objective To investigate the surgical technique of laparoscopic treatment for difficult gastric duodenal ulcer perforation. Methods The clinical data of 28 cases of difficult gastric duodenal ulcer perforation， who were treated with laparoscopic surgery and met the inclusion criteria in our hospital from October 2007 to April 2017 and were retrospectively analyzed. The causes of difficult treatment and its surgical strategy were summarized. Results The operation was difficult for the following reasons： The location of the lesion was difficult to locate and the perforation was difficult to repair. There were 10 cases of duodenal ulcer perforation and 10 cases of gastric antrum perforation， respectively（accounting for 71.4%）， followed by perforation of lesser curvature of stomach and perforation of the posterior wall（3 cases of each， totally proportion 21.4%）. The ulcer size was 10-20 mm（accounting for 96.4%）. Laparoscopic repair was performed in 25 patients， with a mean operative time（84.0±15.0） min. The average postoperative exhaust time was（26.0±12.5）h. There were no complications such as abdominal infection， repair leakage. The average hospital stay was（6.3±1.6）d after operation. At 3 months after operation， 25 cases were examined by gastroscopy， all of which showed the healing of ulcer. Conclusion Laparoscopic neoplasty for difficult gastroduodenal ulcer perforation， as long as the operators have skilled operative techn