Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, PO 3050, Doha, Qatar.
Singapore Med J. 2013 Apr;54(4):216-9. doi: 10.11622/smedj.2013076.
Laparoscopic simple closure (LSC) coupled with Helicobacter pylori eradication is a well-recognised treatment for perforated duodenal ulcers. This study aimed to evaluate its safety and efficacy.
This was a retrospective cohort study conducted on patients who underwent LSC of perforated duodenal ulcers from January 2002 to December 2009. Patients were stratified according to the American Society of Anesthesiologist classification and Boey's risk score.
Of the 213 patients, 22 (10.3%) were excluded as they required conversion to open surgery. 191 (89.7%) patients who underwent successful laparoscopic repair were included in the study. The median age of the patients was 39 (range 19-73) years, and the majority were male (n = 180, 94%). Median duration of pre-hospital symptoms was eight hours and median time from admission to surgery was six hours. Median operative time was 65 minutes and median hospital stay was five days. Ten patients (median age 53.5 years) required intensive care unit admission. Two patients developed leakage from the suture line - one required re-exploration and the other was managed conservatively. Four patients had intra-abdominal abscesses - one required re-exploration, while three were managed by percutaneous radiological drainage. One patient developed pneumonia and one had pulmonary embolism. There were no surgical site infections. All patients were followed up as surgical outpatients (median duration 36 days). None of the patients required definitive surgery. There was one death in the cohort.
LSC of perforated duodenal ulcers is a reliable, safe and minimally invasive procedure that has low morbidity.
腹腔镜单纯缝合（LSC）联合幽门螺杆菌根除是一种公认的治疗十二指肠溃疡穿孔的方法。本研究旨在评估其安全性和疗效。
这是一项回顾性队列研究，对 2002 年 1 月至 2009 年 12 月期间接受腹腔镜十二指肠溃疡穿孔修补术的患者进行研究。患者根据美国麻醉医师协会分类和 Boey 风险评分进行分层。
213 例患者中，22 例（10.3%）因需要转为开腹手术而被排除。191 例（89.7%）成功接受腹腔镜修复的患者被纳入研究。患者的中位年龄为 39 岁（范围 19-73 岁），大多数为男性（n=180，94%）。中位发病前症状持续时间为 8 小时，中位入院至手术时间为 6 小时。中位手术时间为 65 分钟，中位住院时间为 5 天。10 例患者（中位年龄 53.5 岁）需要入住重症监护病房。2 例患者出现缝线渗漏-1 例需要再次探查，另 1 例保守治疗。4 例患者发生腹腔脓肿-1 例需要再次探查，3 例经皮放射学引流治疗。1 例患者发生肺炎，1 例发生肺栓塞。无手术部位感染。所有患者均作为外科门诊患者进行随访（中位随访时间 36 天）。无患者需要确定性手术。该队列中有 1 例死亡。
腹腔镜单纯缝合治疗十二指肠溃疡穿孔是一种可靠、安全和微创的方法，其发病率较低。
