Pescatore P, Halkic N, Calmes J M, Blum A, Gillet M
Division de Gastroentérologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Gastrointest Endosc. 1998 Oct;48(4):411-4. doi: 10.1016/s0016-5107(98)70013-6.
Laparoscopic techniques have been proposed as an alternative to open surgery for therapy of peptic ulcer perforation. They provide better postoperative comfort and absence of parietal complications, but leakage occurs in 5% of cases. We describe a new method combining laparoscopy and endoluminal endoscopy, designed to ensure complete closure of the perforation.
Six patients with anterior ulcer perforations (4 duodenal, 2 gastric) underwent a concomitant laparoscopy and endoluminal endoscopy with closure of the orifice by an omental plug attracted into the digestive tract.
All perforations were sealed. The mean operating time was 72 minutes. The mean hospital stay was 5.5 days. There was no morbidity and no mortality. At the 30-day evaluation all ulcers but one (due to Helicobacter pylori persistence) were healed.
This method is safe and effective. Its advantages compared with open surgery or laparoscopic patching as well as its cost-effectiveness should be studied in prospective randomized trials.
腹腔镜技术已被提议作为治疗消化性溃疡穿孔的开放手术的替代方法。它们能提供更好的术后舒适度且无腹壁并发症，但有5%的病例会发生渗漏。我们描述了一种结合腹腔镜和腔内内镜检查的新方法，旨在确保穿孔完全闭合。
6例前壁溃疡穿孔患者（4例十二指肠溃疡，2例胃溃疡）接受了腹腔镜和腔内内镜联合检查，通过吸引至消化道的网膜补片封闭穿孔口。
所有穿孔均被封闭。平均手术时间为72分钟。平均住院时间为5.5天。无并发症发生，无死亡病例。在30天评估时，除1例（因幽门螺杆菌持续存在）外，所有溃疡均愈合。
该方法安全有效。与开放手术或腹腔镜修补相比，其优势以及成本效益应在前瞻性随机试验中进行研究。
