Gouta Esma Leila, Dougaz Wejih, Khalfallah Mehdi, Bouasker Ibtissem, Dziri Chadli
Tunis Med. 2018 Jul;96(7):424-429.
Laparoscopic surgery has become the gold standard for many procedures owing to its advantages such as a shorter post-operative stay, a faster recovery and less postoperative pain. However, choosing laparoscopic approach in an emergency situationsuch as in the management of a perforated duodenal peptic ulcer is still debated because of the absence of significant benefits. This study aimed to assess the management of perforated duodenal peptic ulcer treated by suture.
It's a retrospective study enrolling 81 patients operated on for duodenal perforated peptic ulcer between June 1st, 2012 and December 31st, 2016 who underwent surgery in the surgical department B of Charles Nicolle's Hospital.
Our retrospective study showed that laparoscopic approach had shorter post-operative duration (3 [1-5] versus 4 [1-16] days, respectively, p< 0.001), shorter mortality rate (3% versus 19%, p=0.032) and more uneventful post-operative course (97% versus 74%, p=0.004) comparing to the open approach. Patients who were not admitted in the intensive care unit during the first 48 hours had 9.901 more chance to be operated by laparoscopic approach. Patients who were operated on by a senior had 3.240 times more chance to be operated by laparoscopic approach. There was no predictive variable for conversion. Mortality rate was 11%. Age was the only predictive independent factor of mortality with a cut-off point of 47 years.
Laparoscopic approach is routinely practised in the perforated duodenal ulcer. In our study, we showed that laparoscopic approach had less post-operative complications, a lower rate of mortality and a shorter post-operative duration comparing to the open approach. The main limitation of our study was non-randomization and lack of laparoscopic expertise. The decision for either open or laparoscopic approach was then dependent on senior surgeon's availability.
由于腹腔镜手术具有术后住院时间短、恢复快和术后疼痛轻等优点，已成为许多手术的金标准。然而，在紧急情况下，如处理十二指肠消化性溃疡穿孔时选择腹腔镜手术方法仍存在争议，因为其优势并不显著。本研究旨在评估经缝合治疗的十二指肠消化性溃疡穿孔的处理方法。
这是一项回顾性研究，纳入了2012年6月1日至2016年12月31日期间在查尔斯·尼科勒医院B外科接受十二指肠穿孔性消化性溃疡手术的81例患者。
我们的回顾性研究表明，与开放手术相比，腹腔镜手术的术后持续时间更短（分别为3[1 - 5]天和4[1 - 16]天，p < 0.001），死亡率更低（3%对19%，p = 0.032），术后过程更平稳（97%对74%，p = 0.004）。在最初48小时内未入住重症监护病房的患者接受腹腔镜手术的可能性高9.901倍。由资深医生进行手术的患者接受腹腔镜手术的可能性高3.240倍。没有预测转为开放手术的变量。死亡率为11%。年龄是死亡率的唯一独立预测因素，临界值为47岁。
腹腔镜手术方法常用于十二指肠溃疡穿孔。在我们的研究中，我们表明与开放手术相比，腹腔镜手术的术后并发症更少，死亡率更低，术后持续时间更短。我们研究的主要局限性是非随机化和缺乏腹腔镜专业知识。开放手术还是腹腔镜手术的决策随后取决于资深外科医生的可用性。
