Abid M, Ben Amar M, Guirat Moheddine A, Cheikhrouhou H, Amouri A, Khlif M, Mzali R, Frikha F, Beyrouti M I
Service de chirurgie géndrale, Hôpital Habib Bourguiba, Sfax, Tunisie.
Med Trop (Mars). 2009 Dec;69(6):569-72.
The purpose of this study was to evaluate the feasibility, efficacy and safety of the laporascopic treatment of perforated duodenal ulcer.
This retrospective study included patients who underwent laparoscopic treatment of perforated duodenal ulcer during the seven-year period from 2001 to 2007. The procedure included direct suture of the perforated ulcer followed by peritoneal lavage. All patients received medical treatment including Helicobacter pylori eradication and proton pump inhibitor therapy.
A total of 84 patients underwent laparoscopic surgery for perforated duodenal ulcer during the study period. There were 81 men and 3 women with a mean age of 28 years. Laparoscopic examination confirmed diagnosis of perforated duodenal ulcer in all cases. Direct suture of the ulcer was successful in 72 cases. In the remaining 12 cases conversion to open surgery was necessary due to difficulty in achieving peritoneal lavage in 6 cases, ulcer size and edge friability in 5, and septic shock in one. The mean duration of the procedure was 95 minutes (range, 60 to 180 minutes). The mean postoperative complication rate was 15.4%. Complications included peritonintis in one case and digestive fistula in one. There were no postoperative deaths. All patients were re-examined after 25 months. Two patients presented recurrences after the laparoscopic treatment and required tri-therapy.
Laparoscopic suture of perforated duodenal ulcer is safe and effective. It avoids the need for laparotomy that is associated with a risk for septic and parietal complications. Since medical treatment is effective for ulcerous disease, there are currently no indications for radical treatment.
本研究旨在评估腹腔镜治疗十二指肠溃疡穿孔的可行性、疗效及安全性。
这项回顾性研究纳入了2001年至2007年这七年期间接受腹腔镜治疗十二指肠溃疡穿孔的患者。手术步骤包括对穿孔溃疡进行直接缝合，随后进行腹腔灌洗。所有患者均接受包括根除幽门螺杆菌和质子泵抑制剂治疗在内的药物治疗。
在研究期间，共有84例患者接受了腹腔镜手术治疗十二指肠溃疡穿孔。其中男性81例，女性3例，平均年龄28岁。腹腔镜检查确诊所有病例均为十二指肠溃疡穿孔。72例患者溃疡直接缝合成功。其余12例中，6例因腹腔灌洗困难、5例因溃疡大小及边缘脆弱、1例因感染性休克而转为开放手术。手术平均时长为95分钟（范围60至180分钟）。术后平均并发症发生率为15.4%。并发症包括1例腹膜炎和1例消化瘘。无术后死亡病例。所有患者在25个月后进行复查。2例患者在腹腔镜治疗后复发，需要三联疗法。
腹腔镜缝合十二指肠溃疡穿孔安全有效。它避免了与感染性和腹壁并发症风险相关的开腹手术。由于药物治疗对溃疡病有效，目前尚无根治性治疗的指征。
