Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Asian J Surg. 2022 Apr;45(4):1007-1013. doi: 10.1016/j.asjsur.2021.08.059. Epub 2021 Sep 27.
Despite the acceptance of the laparoscopic approach for the treatment of perforated peptic ulcers, its definitive implantation is still a matter of discussion. We performed a comparative study between the open and laparoscopic approach focused on postoperative surgical complications.
Retrospective observational study in which patients operated on for perforated peptic ulcus in our center between 2001 and 2017 were analyzed. Only those in whom suture and/or omentoplasty had been performed were selected, either for open or laparoscopic approach. Demographic, clinical, and intraoperative variables, complications, mortality and length of stay were collected. Both groups, open and laparoscopic surgery patients, were compared.
The final study sample was 250 patients, 190 (76%) men and 60 (24%) women, mean age 54 years (SD ± 16.7). In 129 cases (52%), the surgical approach was open, and in 121 (48%) it was laparoscopic. Grades III-V complications of the Clavien-Dindo Classification occurred in 23 cases (9%). Operative mortality was 1.2% (3 patients). Laparoscopically operated patients had significantly fewer complications (p = 0.001) and shorter hospital stay (p < 0.001). In multivariate analysis, laparoscopic approach (p = 0.025; OR:0.45-95%CI: 0.22-0.91), age (p = 0.003; OR:1.03-95%CI: 1.01-1.06), and Boey score (p = 0.024 - OR:1.71 - CI95%: 1.07-2.72), were independent prognostic factors for postoperative surgical complications.
Laparoscopic surgery should be considered the first-choice approach for patients with perforated peptic ulcer. It is significantly associated with fewer postoperative complications and a shorter hospital stay than the open approach.
尽管腹腔镜方法已被接受用于治疗穿孔性消化性溃疡，但它的确定性植入仍然是一个讨论的话题。我们进行了一项比较研究，比较了开放手术和腹腔镜手术在术后手术并发症方面的差异。
回顾性观察性研究，分析了 2001 年至 2017 年期间在我们中心接受穿孔性消化性溃疡手术的患者。仅选择接受缝合和/或大网膜修补术的患者，无论采用开放手术还是腹腔镜手术。收集人口统计学、临床和术中变量、并发症、死亡率和住院时间。比较开放手术和腹腔镜手术患者。
最终的研究样本为 250 例患者，其中 190 例（76%）为男性，60 例（24%）为女性，平均年龄为 54 岁（标准差±16.7）。在 129 例（52%）患者中，手术方式为开放手术，121 例（48%）为腹腔镜手术。Clavien-Dindo 分类的 III-V 级并发症发生在 23 例（9%）患者中。手术死亡率为 1.2%（3 例）。腹腔镜手术患者的并发症明显较少（p=0.001），住院时间较短（p<0.001）。多因素分析显示，腹腔镜手术（p=0.025；比值比：0.45-95%可信区间：0.22-0.91）、年龄（p=0.003；比值比：1.03-95%可信区间：1.01-1.06）和 Boey 评分（p=0.024-比值比：1.71-95%可信区间：1.07-2.72）是术后手术并发症的独立预后因素。
腹腔镜手术应被视为穿孔性消化性溃疡患者的首选方法。与开放手术相比，它与较少的术后并发症和较短的住院时间显著相关。
