3种术式治疗胃十二指肠溃疡急性穿孔的比较
Comparison of the effects of three methods for treating acute perforation of gastroduodenal ulcer
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摘要: 目的: 比较腹腔镜下穿孔修补术、开腹穿孔修补术和开腹胃大部切除术治疗胃十二指肠溃疡急性穿孔的临床效果。方法: 207例胃十二指肠溃疡急性穿孔患者中,90例行腹腔镜下穿孔修补术(腹腔镜修补组),55例行开腹穿孔修补术(开腹修补组),62例行开腹胃大部切除术(胃大部切除组),比较3组术后的疗效。结果: 3组均无近期手术死亡病例,治愈率为100%。腹腔镜修补组、开腹修补组、胃大部切除组术后远期疗效优良率分别为94.2%、94.2%和93.3%,差异无统计学意义(P＞0.05);但腹腔镜修补组术后住院时间、并发症、术后肠蠕动恢复时间,优于修补组和胃大部切除组(P＜0.05)。结论: 胃十二指肠溃疡急性穿孔在排除恶性溃疡、瘢痕性幽门梗阻、溃疡并发出血等情况下,腹腔镜下穿孔修补术可作为首选术式。Abstract: Objective: To analyze and compare the effectiveness of treatment for acute perforation of gastroduodenal ulcer with simple repair under laparoscopy, laparotomy repair and subtotal gastrectomy.Methods: The long or short term effect of 207 cases with acute perforation of astroduodenal ulcer were analyzed including 90 cases treated with simple repair under laparoscopy, 55 cases treated with laparotomy repair and 62 cases treated with subtotal gastrectomy.Results: No death case occurred and cure rate was 100%.The good short-term curative effect in simple repair under laparoscopy, laparotomy repair and subtotal gastrectomy 94.2%, 94.2% and 93.3%, respectively.There was no significant differece in long-term effect of all cases(P ＞ 0.05),but the incidence of pain, complications and recovery time of intestinal peristalsis of simple repair under laparoscopy were superior to laparotomy repair and subtotal gastrectomy(P＜0.05)in hospital stay.Conclusions: Simple repair under laparoscopy is the best choice for treating acute perforation of gastroduodenal ulcer without malignant ulcer, cicatricial pyloric obstruction and ulcer blooding.
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