Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
J Gastric Cancer. 2012 Dec;12(4):237-42. doi: 10.5230/jgc.2012.12.4.237. Epub 2012 Dec 31.
Despite the great advances in laparoscopic techniques, most active general surgeons do not apply laparoscopic surgery in the treatment of duodenal ulcer perforation when facing a real-life emergency. Therefore, our study was designed to evaluate the feasibility of laparoscopic surgery in duodenal ulcer perforation, and provide a step-by-step protocol with tips and recommendations for less experienced surgeons.
Between March, 2011 and May, 2012, 21 patients presenting with duodenal ulcer perforation underwent laparoscopic primary repair with omentopexy. There were no contraindications to perform laparoscopic surgery, and the choice of primary repair was decided according to the size of the perforation. The procedure for laparoscopic primary repair with omentopexy consisted of peritoneal lavage, primary suture, and omentopexy using a knot pusher.
During the operation, no conversion to open surgery or intra-operative events occurred. The median operation time was 45.0 minutes (2080 minutes). Median day of commencement of a soft diet was day 6 (417 days). After surgery, the median hospital stay was 8.0 days (5~27 days). Postoperative complications occurred in one patient, which included a minor leakage. This complication was resolved by conservative management.
Although our study was carried out on a small number of patients at a single institution, we conclude that laparoscopic primary repair can be an effective surgical method in the treatment of duodenal ulcer perforation. We believe that the detailed explanation of our procedure will help beginners to perform laparoscopic primary repair more easily.
尽管腹腔镜技术取得了巨大进展，但大多数活跃的普外科医生在面对真实紧急情况时，并未将腹腔镜手术应用于十二指肠溃疡穿孔的治疗。因此，我们的研究旨在评估腹腔镜手术治疗十二指肠溃疡穿孔的可行性，并为经验较少的外科医生提供分步方案以及技巧和建议。
2011 年 3 月至 2012 年 5 月，21 例十二指肠溃疡穿孔患者接受了腹腔镜一期修补加大网膜固定术。没有腹腔镜手术的禁忌证，且根据穿孔的大小决定采用一期修补术。腹腔镜一期修补加大网膜固定术的步骤包括腹腔冲洗、一期缝合和使用推结器进行大网膜固定。
手术过程中，无中转开腹或术中并发症发生。手术时间中位数为 45.0 分钟（2080 分钟）。开始软食的中位数时间为术后第 6 天（417 天）。术后，中位数住院时间为 8.0 天（5~27 天）。术后 1 例患者发生并发症，包括轻微漏液。该并发症经保守治疗得到解决。
尽管我们的研究仅在单中心进行，且纳入的患者数量较少，但我们认为腹腔镜一期修补术可作为十二指肠溃疡穿孔的有效治疗方法。我们相信，对手术步骤的详细解释将有助于初学者更轻松地开展腹腔镜一期修补术。
