开放性与腹腔镜修补穿孔性消化性溃疡
Open vs laparoscopic repair of perforated peptic ulcer.
作者信息
Bergamaschi R, Mårvik R, Johnsen G, Thoresen J E, Ystgaard B, Myrvold H E
机构信息
Division of Gastrointestinal Surgery, Department of Surgery and National Center for Advanced Laparoscopic Surgery, University Hospital of Trondheim, Olav Kyrres Gate 17, Trondheim 7006, Norway.
出版信息
Surg Endosc. 1999 Jul;13(7):679-82. doi: 10.1007/s004649901072.
BACKGROUND
Most studies have found that the only advantage to the laparoscopic treatment of perforated peptic ulcer is a reduced need for postoperative analgesia. Therefore, we set out to assess the short-term outcome of open (OR) versus laparoscopic (LR) repair of perforated peptic ulcer.
METHODS
A total of 62 consecutive OR patients were compared with a concurrent cohort of 17 diagnosis-matched LR controls treated at the same hospital between 1991 and 1996.
RESULTS
The OR and LR patients were comparable for age, weight, American Society of Anesthesiologists (ASA) grade, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Boey score, ulcer site, Mannheim Peritonitis Index (MPI), delay of surgery, Helicobacter pylori infection, nonsteroidal antiinflammatory drug (NSAID) intake, and previous abdominal surgery. More LR than OR patients were operated on by staff surgeons (chi2 = 46.9, 1 d.f., p << 0.01). Mortality (OR: 12, LR: two), morbidity (OR: eight, LR: two), estimated blood loss (OR: 120 ml, LR: 95 ml), solid food intake resumption (OR: 5 days, LR 4 days), NSAID consumption (OR: 2,225 mg, LR: 1,815 mg), delayed gastric emptying (OR: two, OR: one), and hospital stay (OR: 9 days, LR: 7 days) were not significantly different for the two groups. Four LR patients (23. 5%) were converted to OR due to failure to progress (n = 3) or posterior perforation (n = 1). Operating time was shorter in OR patients (65 min versus 92 min, p << 0.01). LR patients had reduced opioid consumption (256 mg versus 134 mg, p << 0.01). One LR and 16 OR patients were lost to follow-up. Median follow-up was 14 months (range, 2-55) and 18 months (range, 1-62) in OR and LR patients, respectively. There were more LR than OR patients with Visick score I (p = 0.002) and more OR than LR patients with Visick score II (p = 0.0001). Scores III and IV did not differ significantly.
CONCLUSION
The laparoscopic repair of perforated peptic ulcer does not yield any additional benefits over the open repair.
背景
大多数研究发现，腹腔镜治疗穿孔性消化性溃疡的唯一优势是术后镇痛需求减少。因此，我们着手评估开放性（OR）与腹腔镜（LR）修补穿孔性消化性溃疡的短期疗效。
方法
1991年至1996年期间，在同一家医院对62例连续性OR患者与17例诊断匹配的LR对照同期队列患者进行了比较。
结果
OR组和LR组患者在年龄、体重、美国麻醉医师协会（ASA）分级、急性生理与慢性健康状况评估（APACHE II）评分、Boey评分、溃疡部位、曼海姆腹膜炎指数（MPI）、手术延迟、幽门螺杆菌感染、非甾体抗炎药（NSAID）摄入以及既往腹部手术方面具有可比性。由 staff surgeons 实施手术的LR组患者多于OR组患者（χ² = 46.9，自由度为1，p << 0.01）。两组患者的死亡率（OR组：12例，LR组：2例）、发病率（OR组：8例，LR组：2例）、估计失血量（OR组：120 ml，LR组：95 ml）、固体食物摄入恢复时间（OR组：5天，LR组：4天）、NSAID消耗量（OR组：2225 mg，LR组：1815 mg）、胃排空延迟（OR组：2例，LR组：1例）以及住院时间（OR组：九天，LR组：七天）无显著差异。4例LR患者（23.5%）因进展不顺利（n = 3）或后壁穿孔（n = 1）转为OR手术。OR组患者的手术时间较短（65分钟对92分钟，p << 0.01）。LR组患者的阿片类药物消耗量减少（256 mg对134 mg，p << 0.01）。1例LR患者和16例OR患者失访。OR组和LR组患者的中位随访时间分别为14个月（范围2 - 55个月）和18个月（范围1 - 62个月）。Visick评分I级的LR组患者多于OR组患者（p = 0.002），Visick评分II级的OR组患者多于LR组患者（p = 0.0001）。III级和IV级评分无显著差异。
结论
腹腔镜修补穿孔性消化性溃疡与开放性修补相比没有任何额外益处。
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