Smith Rohan Stuart, Sundaramurthy Senthilkumar Rajavel, Croagh Daniel
Department of Upper Gastrointestinal/Hepatopancreaticobiliary Surgery, Monash Medical Centre, Melbourne, Victoria, Australia.
Asian J Endosc Surg. 2019 Apr;12(2):139-144. doi: 10.1111/ases.12600. Epub 2018 May 27.
Perforated peptic ulcer disease (PPU) is a condition subject to wide geographical variations in incidence. It remains a significant cause of morbidity and mortality, even in the era of Helicobacter pylori eradication and proton-pump inhibitor therapy. There is no clear consensus on whether laparoscopic or open approaches are superior, and with most studies in this area originating from Europe and Asia, Australian data addressing this issue are lacking.
This retrospective cohort study included all patients who underwent surgery for PPU within a hospital network in Australia. Baseline variables and primary outcomes, including length of hospital stay, chest and abdominal complications, and mortality, were recorded. Secondary outcomes, including reasons for conversion, were also considered.
In total, 109 patients underwent operations for PPU between January 2011 and December 2015. There were no significant differences with regard to baseline comorbidities. There were no statistically significant differences in terms of median length of hospital stay or rates of chest and abdominal complications, but the operative time was 28.5 min longer (P = <0.001) in the laparoscopic group than in the open group.
Open operations were faster to perform than laparoscopic operations for repair of PPU. Despite increased experience treating many surgical diseases laparoscopically, this study did not find it to be superior in terms of length of hospital stay or complication rates.
穿孔性消化性溃疡疾病（PPU）的发病率在地域上存在很大差异。即使在幽门螺杆菌根除和质子泵抑制剂治疗的时代，它仍然是发病和死亡的重要原因。对于腹腔镜手术和开放手术哪种方法更具优势，目前尚无明确共识，而且该领域的大多数研究都来自欧洲和亚洲，缺乏澳大利亚关于这个问题的数据。
这项回顾性队列研究纳入了澳大利亚一个医院网络内所有接受PPU手术的患者。记录基线变量和主要结局，包括住院时间、胸部和腹部并发症以及死亡率。还考虑了次要结局，包括中转手术的原因。
2011年1月至2015年12月期间，共有109例患者接受了PPU手术。基线合并症方面无显著差异。住院时间中位数或胸部和腹部并发症发生率在统计学上无显著差异，但腹腔镜组的手术时间比开放组长28.5分钟（P = <0.001）。
对于PPU修复，开放手术的执行速度比腹腔镜手术更快。尽管腹腔镜治疗许多外科疾病的经验有所增加，但本研究并未发现其在住院时间或并发症发生率方面更具优势。
