Lin Being-Chuan, Liao Chien-Hung, Wang Shang-Yu, Hwang Tsann-Long
Division of Trauma & Emergency Surgery, Department of Surgery, Chang Gung University, Tao-Yuan City, Taiwan.
Division of Trauma & Emergency Surgery, Department of Surgery, Chang Gung University, Tao-Yuan City, Taiwan.
J Surg Res. 2017 Dec;220:341-345. doi: 10.1016/j.jss.2017.07.034. Epub 2017 Aug 19.
This report presents our experience with laparoscopic repair performed in 118 consecutive patients diagnosed with a perforated peptic ulcer (PPU). We compared the surgical outcome of simple closure with modified Cellan-Jones omentopexy and report the safety and benefit of simple closure.
From January 2010 to December 2014, 118 patients with PPU underwent laparoscopic repair with simple closure (n = 27) or omentopexy (n = 91). Charts were retrospectively reviewed for demographic characteristics and outcome. The data were compared by Fisher's exact test, Mann-Whitney U test, Pearson's chi-square test, and the Kruskal-Wallis test. The results were considered statistically significant if P < 0.05.
No patients died, whereas three incurred leakage. After matching, the simple closure and omentopexy groups had similarity in sex, systolic blood pressure, pulse rate, respiratory rate, Boey score, Charlson comorbidity index, Mannheim peritonitis index, and leakage. There were statistically significant differences in age, length of hospital stay, perforated size, and operating time. Comparison of the operating time in the ≤4.0 mm and 5.0-12 mm groups revealed that the simple closure took less time than omentopexy in both groups (≤4.0 mm, 76 versus 133 minutes, P < 0.0001; 5.0-12 mm, 97 versus 139.5 minutes; P = 0.006).
Compared to the omentopexy, laparoscopic simple closure is a safe procedure and shortens the operating time.
本报告介绍了我们对118例连续诊断为消化性溃疡穿孔（PPU）患者进行腹腔镜修复的经验。我们比较了单纯缝合与改良Cellan-Jones网膜固定术的手术结果，并报告了单纯缝合的安全性和益处。
2010年1月至2014年12月，118例PPU患者接受了腹腔镜修复，其中单纯缝合（n = 27）或网膜固定术（n = 91）。回顾性分析病历以获取人口统计学特征和结果。数据通过Fisher精确检验、Mann-Whitney U检验、Pearson卡方检验和Kruskal-Wallis检验进行比较。如果P < 0.05，则结果被认为具有统计学意义。
无患者死亡，3例发生渗漏。匹配后，单纯缝合组和网膜固定术组在性别、收缩压、脉搏率、呼吸率、Boey评分、Charlson合并症指数、曼海姆腹膜炎指数和渗漏方面具有相似性。在年龄、住院时间、穿孔大小和手术时间方面存在统计学显著差异。比较≤4.0mm和5.0 - 12mm组的手术时间发现，两组中单纯缝合的时间均比网膜固定术短（≤4.0mm，76分钟对133分钟，P < 0.0001；5.0 - 12mm，97分钟对139.5分钟；P = 0.006）。
与网膜固定术相比，腹腔镜单纯缝合是一种安全的手术方法，可缩短手术时间。
