L'Helgouarc'h J L, Peschaud F, Benoit L, Goudet P, Cougard P
Service de Chirurgie viscérale et Urgences, CHRU de Dijon.
Presse Med. 2000 Sep 23;29(27):1504-6.
Laparoscopic treatment of perforated duodenal ulcer is an alternative to laparotomy. We reviewed our experience to determine feasibility and reliability of the surgical procedure and the subsequent morbidity and mortality.
This was a retrospective series of 35 patients who underwent laparoscopic repair of perforated duodenal ulcers between January 1994 and November 1999. The perforation was closed by interrupted sutures in 86% of cases associated with irrigation-suction of the abdominal cavity.
Two complications were observed: pyloric stenosis in one patient with a large perforation and Douglas pouch abscess in another. Conversion to laparotomy was necessary in 8 cases: in 2 of them the edges of the perforation were fragile, in 3 the perforation could not be identified (posterior position), and in 3 intraabdominal adhesions were important. There were no deaths. The 2-year results are quite satisfactory.
This study shows that the laparoscopic procedure is reliable and adapted to treat ulcer perforation if the size is less than 1 cm.
腹腔镜治疗十二指肠溃疡穿孔是剖腹手术的一种替代方法。我们回顾了我们的经验，以确定该手术的可行性、可靠性以及随后的发病率和死亡率。
这是一项回顾性研究，纳入了1994年1月至1999年11月间接受腹腔镜修复十二指肠溃疡穿孔的35例患者。86%的病例通过间断缝合关闭穿孔，并对腹腔进行冲洗吸引。
观察到2例并发症：1例穿孔较大的患者发生幽门狭窄，另1例发生Douglas窝脓肿。8例患者需要转为剖腹手术：其中2例穿孔边缘脆弱，3例无法识别穿孔（后壁穿孔），3例腹腔粘连严重。无死亡病例。2年的结果相当令人满意。
本研究表明，如果溃疡穿孔大小小于1 cm，腹腔镜手术是可靠的，适用于治疗溃疡穿孔。
