[腹腔镜治疗胃十二指肠溃疡穿孔]

[Laparoscopy for perforated gastroduodenal ulcers].

作者信息

Samsonov V T, Ermolov A S, Yartsev P A, Gulyaev A A, Levitsky V D, Kirsanov I I

机构信息

Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia.

Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia; Russian Medical Academy of Continuing Professional Education of Healthcare Ministry of Russia, Moscow, Russia.

出版信息

Khirurgiia (Mosk). 2018(10):23-26. doi: 10.17116/hirurgia201810123.

DOI:10.17116/hirurgia201810123

PMID:30531732

Abstract

AIM

To assess laparoscopy in diagnosis and treatment of patients with perforated gastroduodenal ulcers.

MATERIAL AND METHODS

There were 273 patients with perforated gastroduodenal ulcers who underwent laparoscopy at the Sklifosovsky Research Institute for Emergency Care in 2010-2016. Sample included patients with clinical and instrumental diagnosis of perforated gastroduodenal ulcers, suspected hollow organ perforation including perforated ulcer and other acute abdominal diseases followed by perforated ulcer.

RESULTS

Laparoscopy confirmed diagnosis of perforated gastroduodenal ulcer in 82.5% of patients with clear preoperative diagnosis and in 54.2% of patients with suspected perforated ulcer. Video-assisted closure of the ulcer is possible in 81.7% of patients. Any endoscopic procedure should be started from diagnostic measures. Diagnostic laparoscopy followed by curative laparotomy in 14.6% of patients was able to clarify diagnosis, suture technically difficult perforated ulcer and prevent possible complications.

摘要

目的

评估腹腔镜检查在胃十二指肠溃疡穿孔患者诊断和治疗中的应用。

材料与方法

2010年至2016年期间，斯科利福斯夫斯基急救研究所对273例胃十二指肠溃疡穿孔患者进行了腹腔镜检查。样本包括临床和仪器诊断为胃十二指肠溃疡穿孔的患者、疑似中空器官穿孔（包括溃疡穿孔）以及其他急性腹部疾病继发溃疡穿孔的患者。

结果

在术前诊断明确的患者中，82.5%通过腹腔镜检查确诊为胃十二指肠溃疡穿孔；在疑似溃疡穿孔的患者中，54.2%确诊。81.7%的患者可行视频辅助溃疡闭合术。任何内镜手术都应从诊断措施开始。14.6%的患者先进行诊断性腹腔镜检查，然后进行根治性剖腹手术，这能够明确诊断、缝合技术上困难的穿孔溃疡并预防可能的并发症。