急危重症外科学中的腹腔镜检查：穿孔性十二指肠溃疡的修复。
Laparoscopy in Acute Care Surgery: Repair of Perforated Duodenal Ulcer.
机构信息
Department of Surgery, Kuwait University, Kuwait City, Kuwait,
Department of Surgery, McGill University Health Center, McGill University, Montreal, Québec, Canada.
出版信息
Med Princ Pract. 2019;28(5):442-448. doi: 10.1159/000500107. Epub 2019 Apr 16.
INTRODUCTION
The use of laparoscopic management as a first choice for the treatment of duodenal perforation is gaining ground but is not routine in many centers. In this report, we aim to report our experience with laparoscopy as the first approach for the repair of duodenal perforation.
MATERIALS AND METHODS
This is a retrospective review of patients during our initial experience with the use of laparoscopy for the treatment of duodenal perforation between 2009 and 2013.
RESULTS
A total of 100 patients underwent management of duodenal perforation. Laparoscopy was attempted initially in 76 patients (76%) and completed in 64 patients (64%). The length of hospital stay was shorter in the laparoscopic group (mean 2.6) than in the open group (mean 3.1) (p = 0.008). Complications developed in 14 patients (20%). There was a tendency towards fewer admissions to intensive care, less acute kidney injuries, and less acute respiratory distress syndrome in the laparoscopic group. In patients who underwent laparoscopic surgery, the chances of uneventful recovery were 4.3 times higher than in those patients who underwent open surgery (95% CI 1.3-13.5, p = 0.014).
CONCLUSIONS
Laparoscopy in the treatment of perforated duodenal ulcer is safe and can be utilized as a routine approach for the treatment of this pathology.
简介
腹腔镜治疗十二指肠穿孔的应用逐渐得到认可，但在许多中心尚未常规开展。本研究旨在报告我们应用腹腔镜治疗十二指肠穿孔的经验。
材料与方法
回顾性分析了 2009 年至 2013 年期间我们采用腹腔镜治疗十二指肠穿孔的患者初始经验。
结果
共 100 例患者接受了十二指肠穿孔的治疗。76 例（76%）患者最初尝试了腹腔镜治疗，其中 64 例（64%）完成了腹腔镜治疗。腹腔镜组的住院时间（平均 2.6 天）短于开放组（平均 3.1 天）（p = 0.008）。14 例（20%）患者发生了并发症。腹腔镜组患者入住重症监护病房、急性肾损伤和急性呼吸窘迫综合征的比例较低，这一趋势具有统计学意义。在接受腹腔镜手术的患者中，无并发症恢复的可能性是接受开放手术患者的 4.3 倍（95%CI 1.3-13.5，p = 0.014）。
结论
腹腔镜治疗十二指肠溃疡穿孔是安全的，可以作为治疗这种疾病的常规方法。
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