Stepanyan Suren Agho, Petrosyan Areg Artak, Safaryan Hayk Hovhannes, Yeghiazaryan Hayk Henrik, Aleksanyan Andranik Yuri, Hakobyan Vahe Mkrtich, Papazyan Karen Tigran, Mkrtchyan Mkrtich Hamlet
Department of Surgery 1, Yerevan State Medical University, Yerevan, Armenia.
Wideochir Inne Tech Maloinwazyjne. 2019 Jan;14(1):60-69. doi: 10.5114/wiitm.2018.76281. Epub 2018 Jun 11.
Perforation is a dangerous complication of peptic ulcer disease and requires emergency surgical treatment. In recent decades laparoscopic repair of duodenal perforation has been widely used in emergency abdominal surgery.
To analyze laparoscopic and open surgical treatment of 120 consecutive patients with perforated duodenal ulcer.
The study included a group of 120 consecutive patients, operated on for perforated duodenal ulcer in a single institution. Laparoscopic or open repair with or without an omental patch was performed. The value of the Boey score was investigated in predicting the outcomes of treatment in the entire study group.
In 61 (50.8%) cases open repair was performed, in 56 (46.7%) cases laparoscopic repair, and in 3 (2.5%) cases conversion was performed. In the laparoscopy group the mean hospital stay was 5 days (range: 3-14), in the open group 11.7 days (range: 6-63), and in the conversion group 9.3 days (8-10) (p < 0.001). There was a significant difference between characteristics of patients in the laparoscopic groups: in the second period of laparoscopic procedures (2014-2017) the duration of the operation was significantly shorter and the number of postoperative complications was significantly lower than in the initial study group (2010-2013).
The laparoscopic approach is an effective method for treatment of perforated duodenal ulcer in selected cases. A number of 20-25 cases for the surgeon operating with the laparoscopic method is sufficient to achieve an acceptable level of expertise. More prospective randomized studies are needed to evaluate the effectiveness of laparoscopic repair of perforated duodenal ulcer.
穿孔是消化性溃疡疾病的一种危险并发症，需要紧急手术治疗。近几十年来，十二指肠穿孔的腹腔镜修补术已在急诊腹部手术中广泛应用。
分析120例连续性十二指肠溃疡穿孔患者的腹腔镜手术和开放手术治疗情况。
本研究纳入了在单一机构接受十二指肠溃疡穿孔手术的120例连续性患者。采用有或无网膜补片的腹腔镜或开放修补术。研究了Boey评分在预测整个研究组治疗结果中的价值。
61例（50.8%）采用开放修补术，56例（46.7%）采用腹腔镜修补术，3例（2.5%）进行了中转手术。腹腔镜组平均住院时间为5天（范围：3 - 14天），开放组为11.7天（范围：6 - 63天），中转组为9.3天（8 - 10天）（p < 0.001）。腹腔镜组患者特征存在显著差异：在腹腔镜手术的第二阶段（2014 - 2017年），手术时间明显缩短，术后并发症数量明显低于初始研究组（2010 - 2013年）。
腹腔镜手术方法是治疗部分十二指肠溃疡穿孔病例的有效方法。对于采用腹腔镜方法手术的外科医生来说，20 - 25例病例足以达到可接受的专业水平。需要更多前瞻性随机研究来评估十二指肠溃疡穿孔腹腔镜修补术的有效性。
