Ates Mustafa, Sevil Sedat, Bakircioglu Erhan, Colak Cemil
Department of General Surgery, Malatya State Hospital, Malatya, Turkey.
J Laparoendosc Adv Surg Tech A. 2007 Oct;17(5):615-9. doi: 10.1089/lap.2006.0195.
Laparoscopic surgery, a minimally invasive technique, has recently begun to be used on perforated peptic ulcers effectively and frequently. Nevertheless, most studies have shown that the disadvantages of the laparoscopic treatment of peptic ulcers are a long operation time, a high reoperation rate, and a need for an experienced surgeon. Thus, the objective of the current study was to compare the safety and efficacy of optimized laparoscopic surgery without an omental patch for a perforated peptic ulcer within a shorter operational time with conventional open surgery in a 4-year period.
From May 2002 to June 2006, 35 consecutive patients with a clinical diagnosis of a perforated peptic ulcer were prepared prospectively to undergo either an open or optimized laparoscopic surgery.
Seventeen patients with a perforated peptic ulcer underwent simple laparoscopic repair without an omental patch. Three patients (17.6%) who were begun by the laparoscopic approach had to be converted to open surgery. Eighteen patients underwent conventional open surgery. The mean operative time for laparoscopic repair was 42.10 minutes (range, 35-60), which was significantly shorter than the 55.83 minutes for open repair (range, 35-72; P = 0.001). Postoperative parenteral analgesic requirements were lower after laparoscopic repair (75.0 mg) than that after an open repair procedure (101.39 mg; P = 0.02). There was no statistically significant difference between the procedures in terms of hospital stay (5 vs. 5.33 days; P = 0.37) and the timing of access to normal daily activity (6.8 vs. 7.1 days) (P = 0.54).
Laparoscopic surgery, when optimized by a simple repair without an omental patch and 10 mm of a large-channel aspirator-irrigator, may be safely and effectively applied to the patients with small duodenal perforated peptic ulcers (<10 mm) and because of its having low risk factors. The procedure may be an alternative treatment to other procedures when in experienced hands.
腹腔镜手术作为一种微创技术，近来已开始被有效地且频繁地用于治疗穿孔性消化性溃疡。然而，大多数研究表明，腹腔镜治疗消化性溃疡存在手术时间长、再次手术率高以及需要经验丰富的外科医生等缺点。因此，本研究的目的是在4年时间内，比较在较短手术时间内，无网膜补片的优化腹腔镜手术治疗穿孔性消化性溃疡与传统开放手术的安全性和有效性。
从2002年5月至2006年6月，对35例临床诊断为穿孔性消化性溃疡的连续患者进行前瞻性准备，以接受开放手术或优化腹腔镜手术。
17例穿孔性消化性溃疡患者接受了无网膜补片的单纯腹腔镜修补术。3例（17.6%）最初采用腹腔镜手术入路的患者不得不转为开放手术。18例患者接受了传统开放手术。腹腔镜修补术的平均手术时间为42.10分钟（范围35 - 60分钟），明显短于开放修补术的55.83分钟（范围35 - 72分钟；P = 0.001）。腹腔镜修补术后肠外镇痛药物的需求量（75.0毫克）低于开放修补术后（101.39毫克；P = 0.02）。在住院时间（5天对5.33天；P = 0.37）和恢复正常日常活动的时间（6.8天对7.1天）方面，两种手术方式之间无统计学显著差异（P = 0.54）。
当通过无网膜补片和10毫米大通道吸引冲洗器进行简单修补来优化时，腹腔镜手术可安全有效地应用于小十二指肠穿孔性消化性溃疡（<10毫米）患者，且因其风险因素较低。在经验丰富的医生手中，该手术方式可能是其他手术方式的替代治疗方法。
