Khelifi Slim, Ben Ali Ali, Bouhafa Ahmed, Zghidi Souheil, Ben Maamer Anis, Jaoua Hazem, Oueslati Abdelaziz, Ouertani Fethi, Cherif Abderraouf
Service de Chirurgie Générale. Hôpital Habib Thameur.
Tunis Med. 2008 Feb;86(2):114-7.
The objective of this study is to evaluate the feasibility, efficacy and safety of laparoscopic repair for perforated duodenal ulcer.
One hundred and sixty patients were treated by coelioscopic procedure for a perforated duodenal ulcer. The procedure consists on a suture of perforated ulcer associated with a peritoneal lavage. A medical treatment of Helicobacter pylori associated with an inhibitor of the protons pomp was conducted.
The coelioscopic procedure permitted to confirm the diagnostic of perforated duodenal ulcer in all cases. A simple suture of the ulcer was done in 155 cases. The conversion was compulsory in 5 cases, because of difficulties of the peritoneal lavage in 2 cases, a bleeding associated with perforation of the ulcer in one case and associated stenosis in 2 cases. Mean duration was 90 min (extremes 50 - 120 min). Complications occur in 3,1%. They were post - operative peritonitis in 3 cases and duodenal fistulae in 2 cases. All patients were reviewed at 16 months. A recurrence, either clinical or endoscopic occurs in 4 cases because of no adhesion to medical treatment.
Coelioscopic treatment of perforated duodenal ulcer is a safe and efficacy method. It permits to avoid potential septic and parietal complications of laparotomy. The actual efficacy of medical treatment mustn't allow place to the radical treatment of ulcerous illness.
本研究的目的是评估腹腔镜修补十二指肠溃疡穿孔的可行性、有效性和安全性。
160例十二指肠溃疡穿孔患者接受了腹腔镜手术治疗。该手术包括穿孔溃疡缝合术及腹腔灌洗。同时进行了幽门螺杆菌的药物治疗及质子泵抑制剂治疗。
腹腔镜手术在所有病例中均得以确诊十二指肠溃疡穿孔。155例行溃疡单纯缝合术。5例因腹腔灌洗困难2例、溃疡穿孔伴出血1例、伴发狭窄2例而被迫中转开腹。平均手术时间为90分钟（50 - 120分钟）。并发症发生率为3.1%。其中术后腹膜炎3例，十二指肠瘘2例。所有患者均在16个月时接受复查。4例因未坚持药物治疗出现临床或内镜复发。
腹腔镜治疗十二指肠溃疡穿孔是一种安全有效的方法。它可避免剖腹手术潜在的感染和腹壁并发症。当前药物治疗的实际效果不应妨碍对溃疡病的根治性治疗。
