穿孔性消化性溃疡（PPU）的治疗：一项意大利全国倾向评分匹配队列研究，调查腹腔镜与开放手术的比较。
Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach.
机构信息
Surgery Center, Colorectal Surgery Research Unit - Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico of Rome, Rome, Italy.
Emergency Surgery and Trauma - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
出版信息
Surg Endosc. 2023 Jul;37(7):5137-5149. doi: 10.1007/s00464-023-09998-5. Epub 2023 Mar 21.
BACKGROUND
Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure.
METHODS
A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared.
RESULTS
A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien-Dindo classification, the severity of postoperative complications was statistically different only for C-D 1-2.
CONCLUSIONS
Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay.
背景
穿孔性消化性溃疡（PPU）仍然是一种外科急症，占所有消化性溃疡相关死亡的 37%。手术仍然是标准的治疗方法。腹腔镜方法的益处已经得到充分证实，即使在老年人中也是如此。然而，由于在这种技术的某些技术方面存在不一致的结果，外科医生对采用腹腔镜方法提出了质疑。这导致根据个人经验选择手术方式。我们研究的目的是批判性地评估腹腔镜方法在 PPU 治疗中的应用，将其与开放手术进行比较。
方法
对接受手术治疗 PPU 的患者进行回顾性研究，并进行倾向评分匹配分析。将接受 PPU 修复的患者分为：腹腔镜组（LapA）和开放组（OpenA），比较两组患者的临床病理特征。
结果
共有 453 例患者接受 PPU 单纯修补术。其中，腹腔镜组采用腹腔镜方法的占 49%（222/453 例）。经过倾向评分匹配后，每组纳入 172 例患者（腹腔镜组和开放组）。分析表明，开放组的手术时间更长[开放组：96.4±37.2 分钟比腹腔镜组 88.47±33 分钟，p=0.035]，腹腔镜组的总住院时间更短[开放组 13±12 天比腹腔镜组 10.3±11.4 天，p=0.038]。两组死亡率无统计学差异[开放组 26 例（15.1%）比腹腔镜组 18 例（10.5%），p=0.258]。在发病率方面，腹腔镜组 30 天术后总发病率显著较低[开放组 67 例（39.0%）比腹腔镜组 37 例（21.5%），p=0.002]。根据 Clavien-Dindo 分类进行分层，术后并发症的严重程度仅在 C-D 1-2 方面存在统计学差异。
结论
根据本研究，我们可以支持腹腔镜缝合穿孔性消化性溃疡除了是一种安全的技术外，还可以在术后并发症和住院时间方面提供显著优势。
Zotero 插件