Department of Surgery, San Giovanni Bosco Hospital, piazza Donatori di sangue 3, 10154, Torino, Italy.
World J Emerg Surg. 2009 Jul 29;4:28. doi: 10.1186/1749-7922-4-28.
The literature established that, in patients without Boey's risk factors, laparoscopic repair of perforated peptic ulcers, compared to open repair, is associated to lower wound infection rate, less analgesic use, reduction in post operative pain, shorter hospital stay. Some of the main drawbacks are length of operative time and laparoscopic surgeon's experience in intracorporeal knotting.We, for first, report our preliminary experience of perforated peptic ulcers' laparoscopic repair using Medtronic U-Clip(R).
From January 2008 to June 2008 we performed laparoscopic repair of perforated peptic ulcers using Medtronic U-Clip(R) in 10 consecutive patients (6 men and 4 women, from 20 to 65 years-old of age). All the patients presented with iuxtapyloric perforated peptic ulcer, not greater than 10 mm, without signs of sepsis, free from major illnesses. The mini-invasive procedure was performed both by skilled and non-skilled laparoscopic surgeons under experts' surveillance. After it was recognized, perforation was sutured using U-Clip(R) in a full-thickness manner.
We reported no surgical complications in the peri-operative period. The clinical outcome and time needed to perform the intervention didn't change between skilled and non-skilled surgeons. The follow-up at 30 days was good.
In our experience, the anastomotic device U-Clip(R) simplifies laparoscopic repair of perforated peptic ulcer, avoiding the need to perform knots and making the procedure safe and easier.
文献表明，在无 Boey 危险因素的患者中，与开腹修补相比，腹腔镜修补穿孔性消化性溃疡具有更低的伤口感染率、更少的止痛药物使用、术后疼痛减轻和住院时间缩短等优点。其主要缺点是手术时间较长，以及腹腔镜外科医生在体内打结方面的经验。我们首次报告了使用 Medtronic U-Clip（R）行穿孔性消化性溃疡腹腔镜修补的初步经验。
从 2008 年 1 月至 2008 年 6 月，我们使用 Medtronic U-Clip（R）连续治疗了 10 例穿孔性消化性溃疡患者（6 名男性和 4 名女性，年龄 20-65 岁）。所有患者均为幽门旁穿孔性消化性溃疡，穿孔直径不超过 10mm，无脓毒症迹象，无重大疾病。在专家的监护下，由熟练和非熟练的腹腔镜外科医生进行微创治疗。穿孔识别后，使用 U-Clip（R）全层缝合。
我们报告在围手术期没有手术并发症。熟练和非熟练外科医生之间的手术干预时间和临床结果没有变化。30 天的随访情况良好。
在我们的经验中，吻合装置 U-Clip（R）简化了穿孔性消化性溃疡的腹腔镜修补，避免了打结的需要，使手术更加安全和简单。
