汪小龙 闫金松

[摘要] 目的 探讨应用腹腔镜技术治疗老年人消化道穿孔的临床疗效及应用前景。 方法 方便选取该院于2015年5月—2017年12月收治并采用腹腔镜手术治疗的68例消化道穿孔患者进行回顾性分析，评价手术效果。 结果 术前明确诊断的消化道穿孔，术中探查探查确认为十二指肠球部溃疡穿孔55例，胃溃疡穿孔10例;小肠穿孔3例。所有病例均顺利完成完全腹腔镜手术操作，平均手术时间（89±5.64）min。平均出血量约（ 30±5.68）mL。术后（2.0±0.36）d 下床活动，（2.5±0.46）d 排气排便。术后腹腔残余感染1例，行B超引导下腹腔穿刺引流后1周治愈;余均顺利恢复，平均住院时间（12.0±2.14）d。术后随访6 个月以上，无粘连性肠梗阻和腹腔脓肿发生。 结论 应用腹腔镜技术治疗老年人消化道穿孔时，具有手术切口小，疼痛轻，肠功能恢复快，并发症少等优点，值得临床推广应用。

[关键词] 消化道穿孔;腹腔镜;弥漫性腹膜炎

[中图分类号] R656.6          [文献标识码] A          [文章编号] 1674-0742（2018）08（c）-0092-03

Laparoscopic Treatment of Elderly Patients with Perforation of Digestive Tract

WANG Xiao-long， YAN Jin-song

Department of Gastrointestinal Surgery， Huaian Hospital， Huai'an， Jiangsu Province， 223200 China

[Abstract] Objective To explore the clinical efficacy and application prospects of laparoscopic treatment of perforation of digestive tract in the elderly. Methods A retrospective analysis of 68 patients with perforation of the digestive tract treated in the hospital in May 2015 to December 2017 treated with laparoscopic surgery was performed to evaluate the surgical outcome. Results The perforation of the digestive tract was clearly diagnosed before operation. Intraoperative exploration and exploration confirmed 55 cases of duodenal ulcer perforation， 10 cases of gastric ulcer perforation， and 3 cases of small intestine perforation. All cases were successfully completed laparoscopic surgery， the average operation time （89±5.64）min. The average amount of bleeding was about （30±5.68）mL， postoperative out of bed （2.0±0.36）d， （2.5±0.46）d exhaust defecation. One case of postoperative residual infection in the abdominal cavity was cured after one week of peritoneal puncture and drainage under the guidance of B-ultrasonography. The rest of the patients recovered smoothly and the average length of stay was （12.0±2.14）d. After 6 months of follow-up， no adhesive intestinal obstruction or abdominal abscess occurred. Conclusion Laparoscopic treatment of elderly patients with perforation of the digestive tract has the advantages of small incision， mild pain， rapid recovery of intestinal function and fewer complications. It is worthy of clinical application.

[Key words] Gastrointestinal perforation; Laparoscopy; Diffuse peritonitis

消化道穿孔是胃腸外科常见疾病，急性起病，临床症状较重，病情进展迅速，极易引起感染性休克[1]。其病因为各种消化道引起的消化道穿孔，致肠道细菌和各种消化酶溢入腹腔，引起腹腔严重大量纤维渗出，术后极易引起不同程度的肠粘连[2]。该病的治疗关键在于及时诊断、手术治疗。传统手术是治疗消化道穿孔的主要手段，但是传统手术存在手术时间长，出血量大，术后切口感染、裂开，粘连性肠梗阻，低蛋白血症等缺点[3]。随着腹腔镜技术的成熟，在临床应用越来越广泛，尤其腹部疾病治疗中尤为突出。……