Ben Abid Sadreddine, Mzoughi Zeineb, Attaoui Mohamed Amine, Talbi Ghofrane, Arfa Nafaa, Gharbi Lassaad, Khalfallah Mohamed Taher
Tunis Med. 2014 Dec;92(12):732-6.
feasibility and advantages of laparoscopic approach in performed duodenal ulcer have no longer to be demonstrated. Laparoscopic suture and peritoneal cleaning expose to a conversion rate between 10 and 23%. However less than laparotomy, morbidity of this approach is not absent.
This study aim to analyze factors exposing to conversion after laparoscopic approach of perforred duodenal ulcer. We also aim to define the morbidity of this approach and predictive factors of this morbidity Methods: Retrospective descriptive study was conducted referring all cases of perforated duodenal ulcer treated laparoscopically over a period of ten years, running from January 2000 to December 2010. All patients were operated by laparoscopy with or without conversion. We have noted conversion factors. A statistical analysis with logistic regression was performed whenever we have sought to identify independent risk factors for conversion verified as statistically significant in univariante. The significance level was set at 5%. Analytic univariant and multivariant study was performed to analyze morbidity factors.
290 patients were included. The median age was 34ans.T he intervention was conducted completely laparoscopically in 91.4% of cases. The conversion rate was 8.6%. It was selected as a risk factor for conversion: age> 32 years, a known ulcer, progressive pain, renal function failure, a difficult peritoneal lavage and having a chronic ulcer. Postoperative morbidity was 5.1%. Three independent risk factors of surgical complications were selected: renal failure, age> 45 years, and a chronic ulcer appearance.
Laparoscopic treatment of perforred duodenal ulcer expose to a conversion risk. Morbidity is certainly less than laparotomy and a better Knowledge of predictif's morbidity factors become necessary for a better management of this disease.
腹腔镜手术治疗十二指肠溃疡的可行性和优势已无需再证明。腹腔镜缝合和腹腔清理的中转率在10%至23%之间。然而，与开腹手术相比，这种手术方式的发病率并非不存在。
本研究旨在分析腹腔镜治疗十二指肠溃疡穿孔后中转的相关因素。我们还旨在确定这种手术方式的发病率以及该发病率的预测因素。方法：进行回顾性描述性研究，参考2000年1月至2010年12月这十年间所有接受腹腔镜治疗的十二指肠溃疡穿孔病例。所有患者均接受了腹腔镜手术，有中转或无中转情况。我们记录了中转因素。每当我们试图确定在单变量分析中经统计学验证具有显著意义的中转独立危险因素时，就进行逻辑回归统计分析。显著性水平设定为5%。进行单变量和多变量分析研究以分析发病因素。
纳入290例患者。中位年龄为34岁。91.4%的病例完全通过腹腔镜进行干预。中转率为8.6%。被选为中转危险因素的有：年龄>32岁、已知溃疡、进行性疼痛、肾功能衰竭、腹腔灌洗困难以及存在慢性溃疡。术后发病率为5.1%。选择了三个手术并发症的独立危险因素：肾功能衰竭、年龄>45岁以及慢性溃疡表现。
腹腔镜治疗十二指肠溃疡穿孔存在中转风险。发病率肯定低于开腹手术，更好地了解发病率的预测因素对于更好地管理这种疾病很有必要。
