Lau W Y, Leung K L, Kwong K H, Davey I C, Robertson C, Dawson J J, Chung S C, Li A K
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Ann Surg. 1996 Aug;224(2):131-8. doi: 10.1097/00000658-199608000-00004.
This study compares laparoscopic versus open repair and suture versus sutureless repair of perforated duodenal and juxtapyloric ulcers.
The place of laparoscopic repair of perforated peptic ulcer followed by peritoneal toilet of the peritoneal cavity has been established. Whether repair of the perforated peptic ulcer by the laparoscopic approach is better than conventional open repair and whether sutured repair is better than sutureless repair are both undetermined.
One hundred three patients were randomly allocated to laparoscopic suture repair, laparoscopic sutureless repair, open suture repair, and open sutureless repair.
Laparoscopic repair of perforated peptic ulcer (groups 1 and 2) took significantly longer than open repair (groups 3 and 4; 94.3 +/ 40.3 vs. 53.7 +/ 42.6 minutes: Student's test, p < 0.001), but the amount of analgesic required after laparoscopic repair was significantly less than in open surgery (median 1 dose vs. 3 doses) (Mann-Whitney U test, p = 0.03). There was no significant difference in the four groups of patients in terms of duration of nasogastric aspiration, duration of intravenous drip, total hospital stay, time to resume normal diet, visual analogue scale score for pain in the first 24 hours after surgery, morbidity, reoperation, and mortality rates.
Laparoscopic repair of perforated peptic ulcer is a viable option. Sutureless repair is as safe as suture repair and it takes less time to perform.
本研究比较腹腔镜修补术与开放修补术以及缝合修补术与非缝合修补术治疗十二指肠穿孔和近幽门溃疡的效果。
腹腔镜修补消化性溃疡穿孔并进行腹腔冲洗已得到认可。腹腔镜手术修补消化性溃疡穿孔是否优于传统开放修补术以及缝合修补是否优于非缝合修补均未确定。
103例患者被随机分为腹腔镜缝合修补组、腹腔镜非缝合修补组、开放缝合修补组和开放非缝合修补组。
腹腔镜修补消化性溃疡穿孔（第1组和第2组）所用时间显著长于开放修补术（第3组和第4组；94.3±40.3分钟对53.7±42.6分钟：Student检验，p<0.001），但腹腔镜修补术后所需镇痛药用量显著少于开放手术（中位数1剂对3剂）（Mann-Whitney U检验，p = 0.03）。四组患者在胃肠减压持续时间、静脉滴注持续时间、总住院时间、恢复正常饮食时间、术后24小时内疼痛视觉模拟评分、发病率、再次手术率和死亡率方面无显著差异。
腹腔镜修补消化性溃疡穿孔是一种可行的选择。非缝合修补与缝合修补一样安全，且手术时间更短。
