阎海

[摘要] 目的 探讨腹腔镜治疗老年胃十二指肠穿孔的临床疗效及安全性。 方法 根据手术治疗方式不同将92例老年胃十二指肠穿孔患者分为实验组（52例）和对照组（40例），分别行腹腔镜穿孔修补术和开腹穿孔修补术，比较两组临床疗效及安全性。 结果 实验组患者平均手术时间、术后排气时间、胃肠功能恢复时间和住院时间均短于对照组，术中出血量少于对照组，术后并发症发生率（5.8%）低于对照组（20.0%），差异有统计学意义（P<0.05）；两组术后疗效比较差异无统计学意义（P>0.05）。 结论 腹腔镜手术治疗老年胃十二指肠穿孔微创优势明显，可促进患者术后尽快恢复，且安全性较高，推荐作为临床治疗该类病症的首选术式。

[关键词] 胃十二指肠穿孔；老年患者；腹腔镜手术；微创

[中图分类号] R656.62 [文献标识码] B [文章编号] 1673-9701（2016）25-0036-03

Clinical efficacy and safety of laparoscopy in the treatment of elderly patients with gastric and duodenal perforation

YAN Hai

Department of General Surgery， Central Hospital of Panjin in Liaoning Province， Panjin 124010， China

[Abstract] Objective To analyze the clinical efficacy and safety of laparoscopy in the treatment of elderly patients with gastric and duodenal perforation. Methods A total of 92 elderly patients with gastric and duodenal perforation were divided into experimental group（n=52） who accepted the laparoscopy， and control group（n=40） who accepted the open surgery. The clinical efficacy and safety between the two groups were compared after surgery. Results The surgery duration， the postoperative exhaust time， the time of functional recovery of gastrointestinal tract and the hospitalization time in experimental group were shorter than those in control group. The amount of bleeding during surgery in the experimental group was less than that in the control group. The incidence rate of complication in experimental group（5.8%） was significant lower than that in control group （20.0%） （P<0.05）. There was no significant difference between the two group on the efficacy after operation（P>0.05）. Conclusion The laparoscopy in the treatment of elderly patients with gastric and duodenal perforation has more advantages. The restore time after the laparoscopy is shorter than the traditional procedure. It should be recommended as the first choice in the treatment of gastric and duodenal perforation.

[Key words] Gastric and duodenal perforation； Elderly patient； Laparoscopy； Minimally invasive

胃十二指肠穿孔是消化道溃疡常见并发症，该类病症起病急、发展快，若治疗不及时很可能引发弥漫性腹膜炎，严重者会危及患者的生命安全。老年患者身体各器官呈退行性发展，发生穿孔后致死率较高，已经引起临床高度重视[1]。目前随着微创技术的不断进步，腹腔镜手术在临床上得到广泛应用，其在胃十二指肠穿孔治疗中发挥的作用也越来越大，受到医生和患者的青睐[2]。本研究旨在探讨腹腔镜手术治疗该类病症的临床疗效及安全性，现报道如下。

1 资料与方法

1.1一般资料

我院2014年6月～2016年1月收治老年胃十二指肠穿孔患者92例，来诊时均以上腹痛为主诉，均有胃十二指肠溃疡史，符合胃十二指肠穿孔手术指征，对于存在严重肝肾功能障碍、精神系统疾病、既往上消化道出血史以及胃肠恶性肿瘤患者予以排除。……