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镰状韧带缝合术在消化性溃疡穿孔修补术中的可行性。

The feasibility of falciformopexy in the repair of peptic ulcer perforation.

机构信息

Department of General Surgery, Ankara City Hospital, Ankara-Türkiye.

Department of General Surgery, Niksar State Hospital, Tokat-Türkiye.

出版信息

Ulus Travma Acil Cerrahi Derg. 2023 Oct 27;29(11):1237-1241. doi: 10.14744/tjtes.2023.53246.

Abstract

BACKGROUND

Modified Graham omentopexy is the most commonly used operative technique in the repair of peptic ulcer perfo-ration (PUP); however, there is little data on falciformopexy in the literature. The aim is to investigate the feasibility of falciformopexy in the repair of PUP, comparing with modified Graham omentopexy.

METHODS

Data of 471 patients who were operated for PUP were retrospectively analyzed. Patients' demographics, pre-operative basic laboratory findings, American Society of Anesthesiologists (ASA) status, operative findings, and post-operative complications were recorded. The patients were classified into two groups modified Graham omentopexy and falciformopexy, and then compared with each other in terms of clinical characteristics, operative findings, and post-operative complications.

RESULTS

Modified Graham omentopexy and falciformopexy were performed in 425 (90.2%) and 46 (9.8%) patients, respectively. The two groups were similar in terms of basic patient characteristics and pre-operative laboratory findings (P>0.05). ASA physical status was significantly different between the groups (P=0.001). No statistically significant difference was found between the groups in terms of complications, except for an anastomotic leak. Anastomotic leak was observed more frequently in patients who underwent falciformopexy than in patients with modified Graham omentopexy (P=0.017).

CONCLUSION

Although falciformopexy technique has a higher rate of leak compared to the modified Graham omentopexy method, it should be kept in mind as an alternative method for repair of PUP, especially in cases where omentopexy cannot be applied for various reasons such as the presence of unavailable or unsuitable omentum.

摘要

背景

改良 Graham 网膜瓣修补术是胃十二指肠溃疡穿孔(PUP)修复中最常用的手术方法;然而,文献中关于镰状韧带固定术的数据很少。目的是探讨镰状韧带固定术在 PUP 修复中的可行性,并与改良 Graham 网膜瓣修补术进行比较。

方法

回顾性分析了 471 例接受 PUP 手术的患者数据。记录患者的人口统计学资料、术前基本实验室检查结果、美国麻醉医师协会(ASA)状态、手术发现和术后并发症。患者分为改良 Graham 网膜瓣修补术组和镰状韧带固定术组,然后比较两组的临床特征、手术发现和术后并发症。

结果

改良 Graham 网膜瓣修补术和镰状韧带固定术分别在 425(90.2%)和 46(9.8%)例患者中进行。两组患者的基本特征和术前实验室检查结果相似(P>0.05)。两组患者的 ASA 体格状况存在显著差异(P=0.001)。除吻合口漏外,两组在并发症方面无统计学差异。镰状韧带固定术组吻合口漏的发生率高于改良 Graham 网膜瓣修补术组(P=0.017)。

结论

尽管镰状韧带固定术与改良 Graham 网膜瓣修补术相比,漏的发生率较高,但应将其视为 PUP 修复的替代方法,特别是在由于各种原因无法应用网膜瓣修补术的情况下,例如网膜不可用或不合适。

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本文引用的文献

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Novel approach for peptic ulcer perforation surgery.消化性溃疡穿孔手术的新方法。
Clin Case Rep. 2020 Jun 17;8(10):1937-1939. doi: 10.1002/ccr3.3030. eCollection 2020 Oct.
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Perforated and bleeding peptic ulcer: WSES guidelines.穿孔和出血性消化性溃疡:WSES 指南。
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