Kim Hyun Il, Cho Yu Jeong, Yeom Jong Hoon, Jeon Woo Jae, Kim Min Gyu
Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri, Korea.
Department of Anesthesiology, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri, Korea.
Ann Surg Treat Res. 2021 Apr;100(4):228-234. doi: 10.4174/astr.2021.100.4.228. Epub 2021 Mar 30.
Primary repair is the standard surgical method for treating duodenal ulcer perforations, with very good results usually anticipated because of the simplicity of the associated surgical techniques. Therefore, this study aimed to analyze the risk factors that affect laparoscopic primary repair outcomes for duodenal ulcer perforation.
Between June 2010 and June 2020, 124 patients who underwent laparoscopic primary repair for duodenal ulcer perforations were reviewed. Early surgical outcomes were evaluated and risk factors for postoperative complications were assessed.
All surgeries were performed laparoscopically without open conversion. Multivariate analysis showed that the elderly (over 70 years), and perforations that needed more than 2 stitches for closure were risk factors for overall postoperative complications. Perforations that needed more than 2 stitches and perforations on the superior side of the duodenum were major risk factors for severe postoperative complications. Severe postoperative complications occurred in 6 of the patients, and 1 of them died of multiorgan failure.
Based on our results, we suggest that laparoscopic primary repair can be safely performed in duodenal ulcer perforation. However, more careful surgery and postoperative care are needed to improve the surgical outcomes of patients who need more than 2 stitches to close their perforation or who have perforations on the superior side of the duodenum.
一期修补是治疗十二指肠溃疡穿孔的标准手术方法，由于相关手术技术简单，通常预期效果良好。因此，本研究旨在分析影响十二指肠溃疡穿孔腹腔镜一期修补术预后的危险因素。
回顾2010年6月至2020年6月期间124例行腹腔镜十二指肠溃疡穿孔一期修补术的患者。评估早期手术结果，并评估术后并发症的危险因素。
所有手术均在腹腔镜下完成，未中转开腹。多因素分析显示，年龄较大（70岁以上）以及穿孔闭合需要2针以上缝合是术后总体并发症的危险因素。穿孔闭合需要2针以上缝合以及十二指肠上缘穿孔是术后严重并发症的主要危险因素。6例患者发生严重术后并发症，其中1例死于多器官功能衰竭。
根据我们的研究结果，我们认为腹腔镜一期修补术可安全用于十二指肠溃疡穿孔。然而，对于穿孔闭合需要2针以上缝合或十二指肠上缘穿孔的患者，需要更仔细的手术和术后护理以改善手术效果。
