Ölmez Aydemir, Çiçek Egemen, Aydın Cemalettin, Kaplan Kuntay, Kayaalp Cüneyt
Department of General Surgery, Mersin University Faculty of Medicine, Mersin-Turkey.
Department of General Surgery, İnönü University Faculty of Medicine, Malatya-Turkey.
Ulus Travma Acil Cerrahi Derg. 2019 Nov;25(6):580-584. doi: 10.14744/tjtes.2019.11387.
Open or laparoscopic Graham's omentopexy is frequently used in the treatment of peptic ulcer perforation (PUP). The technical difficulty of applying the omental plug, especially in patients with previous omentum resection, has led to the use of falciform ligament for the PUP, and some studies have reported that PUP may even be a more advantageous technique than omentopexy. Here, in this study, we aimed to compare the retrospective results of patients who underwent falciformopexy or omentopexy for PUP.
Between 1999 and 2018, 303 patients who were followed-up and treated for PUP were included in this study. Patients who had malignancy, gastric resection, definitive ulcer surgery, laparoscopic surgery and nonoperative treatment were excluded from this study. In the remaining patients, either open ometopexy or falciformopexy were applied based on the surgeon's choice. These two techniques were compared for intraoperative and postoperative outcomes.
Falciformopexy (n=46) and omentopexy (n=243) groups had similar demographics, but ASA scores were lower in the falciformopexy group. For ulcer size and localization, duration of operation, no difference was found between the groups. There was no significant difference between the groups concerning general postoperative morbidity and mortality. However, atelectasis was more frequently observed in the omentopexy group, whereas the pexia failure was more frequent in the falciformopexy group (2.6% and 8.7%, p=0.04).
Falciformopexy is an alternative technique that can be used in situations where it is not possible to use the omentum. Falciformopexy is not superior to omentopexy for the repair of the PUP.
开放式或腹腔镜下格雷厄姆大网膜固定术常用于治疗消化性溃疡穿孔（PUP）。应用网膜补片的技术难度，尤其是在既往有网膜切除术的患者中，促使人们将镰状韧带用于PUP的治疗，并且一些研究报告称，PUP甚至可能是比大网膜固定术更具优势的技术。在此项研究中，我们旨在比较接受镰状韧带固定术或大网膜固定术治疗PUP患者的回顾性结果。
1999年至2018年期间，本研究纳入了303例接受PUP随访和治疗的患者。患有恶性肿瘤、胃切除术、确定性溃疡手术、腹腔镜手术和非手术治疗的患者被排除在本研究之外。在其余患者中，根据外科医生的选择采用开放式大网膜固定术或镰状韧带固定术。比较这两种技术的术中及术后结果。
镰状韧带固定术组（n = 46）和大网膜固定术组（n = 243）的人口统计学特征相似，但镰状韧带固定术组的美国麻醉医师协会（ASA）评分较低。在溃疡大小和位置、手术持续时间方面，两组之间未发现差异。两组在总体术后发病率和死亡率方面无显著差异。然而，大网膜固定术组更常观察到肺不张，而镰状韧带固定术组的固定失败更常见（分别为2.6%和8.7%，p = 0.04）。
镰状韧带固定术是一种可在无法使用网膜的情况下使用的替代技术。在修复PUP方面，镰状韧带固定术并不优于大网膜固定术。
