Lunevicius Raimundas, Morkevicius Matas, Stanaitis Juozas
2nd Abdominal Surgery Department, Vilnius University Emergency Hospital, Siltnamiu 29, 04130 Vilnius, Lithuania.
Medicina (Kaunas). 2004;40(11):1054-68.
Clear patient selection criteria and indications for laparoscopic repair of perforated duodenal ulcers are still of relevance. The purpose of our paper is to describe the early outcome results after this operation and to define the risk factors influencing the genesis of postoperative morbidity.
Fifty-one patients were operated on laparoscopically between October 1996 and October 2003 for perforated peptic ulcers. Out of them, 47 patients with perforated duodenal ulcers entered the final retrospective analysis. Twenty variables were identified, including the duration of acute symptoms before the operation, shock, underlying medical illness, ulcer size, age, Boey score and the predictive value of these variables for morbidity, conversion rates and hospital stay. The univariate data analysis was originally done using the Fisher exact test, t test, Mann Whitney, ANOVA and F tests. The data was reevaluated using multifactorial analysis with logistic and linear regression tests.
Patient's age was 32.0+/-12.4 years. Duration of perforation was 8.0+/-10.8 hours. Shock was diagnosed in one patient (2.1%). High surgical risk according to ASA (III-IV) was estimated in 2 patients (4.3%). Laparoscopic duodenography was completed in 36 patients (76.6%). The other 11 patients (23.4%) underwent a conversion to open repair. Seven patients (19.4%) had postoperative complications. Suture leakage was confirmed in 4 patients (11.1%), and other abdominal complications were observed in 3 patients (8.3%). Pneumonia and pneumothorax were diagnosed in 3 patients. Hospital stay was 7.9+/-5.8 (4-45) days. There was no mortality. Ulcer perforation size >4-10 mm is the only significant risk factor influencing the conversion rate. An increase in the suture leakage rate was most significant with delayed presentation of >or=10 hours (p<0.0001). This risk factor influences both the postoperative pneumonia rate (>or=10 hrs., p=0.026) and hospital stay (p<0.05).
Size of duodenal ulcer perforation and duration of ulcer perforation symptoms were found to be risk factors influencing the rates of conversion to open repair and genesis of postoperative morbidity.
明确的患者选择标准以及十二指肠溃疡穿孔腹腔镜修补术的适应证仍然具有重要意义。本文的目的是描述该手术后的早期结果，并确定影响术后发病的危险因素。
1996年10月至2003年10月期间，51例患者接受了腹腔镜下消化性溃疡穿孔修补术。其中，47例十二指肠溃疡穿孔患者进入最终的回顾性分析。确定了20个变量，包括术前急性症状持续时间、休克、基础疾病、溃疡大小、年龄、Boey评分以及这些变量对发病率、中转率和住院时间的预测价值。单因素数据分析最初使用Fisher精确检验、t检验、Mann-Whitney检验、方差分析和F检验。使用逻辑回归和线性回归检验的多因素分析对数据进行重新评估。
患者年龄为32.0±12.4岁。穿孔持续时间为8.0±10.8小时。1例患者（2.1%）诊断为休克。根据美国麻醉医师协会（ASA）分级（III-IV级），估计2例患者（4.3%）手术风险高。36例患者（76.6%）完成了腹腔镜十二指肠造影。其他11例患者（23.4%）中转开腹修补。7例患者（19.4%）出现术后并发症。4例患者（11.1%）证实有缝线渗漏，3例患者（8.3%）观察到其他腹部并发症。3例患者诊断为肺炎和气胸。住院时间为7.9±5.8（4-45）天。无死亡病例。溃疡穿孔大小>4-10mm是影响中转率的唯一显著危险因素。穿孔时间延迟≥10小时，缝线渗漏率增加最为显著（p<0.0001）。该危险因素影响术后肺炎发生率（≥10小时，p=0.026）和住院时间（p<0.05）。
十二指肠溃疡穿孔大小和溃疡穿孔症状持续时间是影响中转开腹修补率和术后发病的危险因素。
