Khoursheed M, Fuad M, Safar H, Dashti H, Behbehani A
Department of Surgery, Faculty of Medicine, Kuwait University, Safat.
Surg Endosc. 2000 Jan;14(1):56-8. doi: 10.1007/s004649900011.
Medical treatment of peptic ulcer is highly successful, and the eradication of Helicobacter pylori (H. pylori) reduces ulcer recurrence. However, the incidence of perforated duodenal ulcer and its associated mortality have not been reduced by modern methods of therapy. Laparoscopic simple closure and omental plug by suturing, fibrin glue, and stapler have been successful.
Over a 1-year period (1996-97), 21 patients with perforated duodenal ulcer were operated on in our hospital by laparoscopic simple closure and omental patch. The mean age was 36.4 +/- 11.8 years (range, 18-61). Twenty patients were male (93.7%). The mean duration of pain was 9.1 +/- 11.7 hs (range, 2-48). Three patients had a previous history of duodenal ulcer (14.3%), and another three (14.3%) patients had a history of nonsteroidal antiinflammatory drug (NSAID) intake. Erect chest radiograph showed that 19 patients had air under the diaphragm (90.5%). Sixteen patients (76.2%) had frank pus in the abdomen, and five patients had a minimal peritoneal reaction (23.8%).
The mean operative time was 71.6 +/- 24.6 mins (range, 40-120), and the mean hospital stay was 5.2 +/- 1.6 days (range, 3-9). The mean time to resume oral fluids was 3.1 +/- 0.8 days (range, 2-4). Only one patient was reoperated due to leakage identified by gastrographin swallow.
This procedure is safe and efficient; however, further study of its long-term effectiveness and comparability to existing therapy is still needed.
消化性溃疡的药物治疗非常成功，根除幽门螺杆菌可降低溃疡复发率。然而，现代治疗方法并未降低十二指肠溃疡穿孔的发生率及其相关死亡率。腹腔镜单纯缝合关闭及用缝合、纤维蛋白胶和吻合器进行网膜填塞已获成功。
在1年期间（1996 - 1997年），我院对21例十二指肠溃疡穿孔患者采用腹腔镜单纯缝合关闭及网膜修补术进行手术治疗。平均年龄为36.4±11.8岁（范围18 - 61岁）。20例为男性（93.7%）。平均疼痛持续时间为9.1±11.7小时（范围2 - 48小时）。3例患者有十二指肠溃疡病史（14.3%），另外3例（14.3%）患者有非甾体抗炎药服用史。立位胸部X线片显示19例患者膈下有气体（90.5%）。16例患者（76.2%）腹腔内有明显脓液，5例患者有轻微腹膜反应（23.8%）。
平均手术时间为71.6±24.6分钟（范围40 - 120分钟），平均住院时间为5.2±1.6天（范围3 - 9天）。恢复口服液体的平均时间为3.1±0.8天（范围2 - 4天）。仅1例患者因泛影葡胺吞咽检查发现渗漏而再次手术。
该手术安全有效；然而，仍需对其长期疗效以及与现有治疗方法的可比性进行进一步研究。
