Urbano D, Rossi M, De Simone P, Berloco P, Alfani D, Cortesini R
II Patologia Chirurgica, Università di Roma La Sapienza, Italy.
Surg Endosc. 1994 Oct;8(10):1208-11. doi: 10.1007/BF00591052.
Surgery--namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers. We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31-81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6-15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months. On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter.
手术——即缝合关闭——仍然是穿孔性消化性溃疡的首选治疗方法，尽管泰勒的保守方法已被证实有效。然而，这种保守治疗在高危患者和穿孔超过12小时的患者中已被证明效果较差。在此，我们提出穿孔性消化性溃疡的替代腹腔镜治疗方法。我们对6例患者进行了腹腔镜治疗（1例女性，5例男性；平均年龄57.6岁；范围31 - 81岁）；平均手术时间为52分钟；中位住院时间为7天（6 - 15天）；口服给予H2受体阻滞剂、抗生素和补液；随访时间为6至18个月。根据我们的经验，对于穿孔性消化性溃疡，当腹膜反应较轻（通常穿孔后不到6小时）时，首选治疗方法是泰勒的保守手术和腹腔镜腹腔引流。如果有明显的腹膜炎（通常超过12小时），必须进行准确的灌洗。当穿孔部位被腹膜炎症掩盖时，不应寻找；当可见时，可用圆韧带或网膜组织束将其堵塞，特别是如果直径大于1厘米。
