Efficacy of Laparoscopic Repair for Gastroduodenal Perforation_West China Medical Journal

Authors：

 ZhaoYuanxun ,  ZhangGuangquan , WuXianlin

Department of General Surgery, the Sixth People's Hospital of Chengdu, Chengdu, Sichuan 610051, P. R. China;

Corresponding?author：

ZhangGuangquan, Email: zhang561919@126.com

Keywords：

Gastroduodenal perforation; Laparoscopy; Perforation repair

DOI：

10.7507/1002-0179.201600369

Video：

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Objective To analyze the surgical effect, postoperative complications and effects on the body inflammatory response of laparoscopic gastroduodenal perforation repair, and to further evaluate the efficacy of laparoscopic perforation repair. Methods We retrospectively analyzed the clinical data of 123 patients with gastroduodenal ulcer perforation treated between February 2010 and February 2015. Among the patients, 65 underwent laparoscopic gastroduodenal ulcer perforation repair (laparoscopic group), and 58 underwent routine open gastroduodenal ulcer perforation repair (open group). Then, we compared the surgical effects (average bleeding volume, ambulation time, postoperative ventilation time, postoperative hospital stay), postoperative complications (wound infection, wound dehiscence, gastroduodenal fistula, abdominal abscess, intestinal obstruction), inflammatory reaction[preoperative and 1, 3, 5-day postoperative white blood cells (WBC) count, peripheral blood procalcitonin (PCT), C-reactive protein (CRP)] between the two groups. Results Patients in both the two groups underwent the surgery successfully. No patients in the laparoscopic group were transferred to open surgery. Compared with the open surgery, surgical bleeding volume, ambulation time, anal exhaust time and postoperative hospital stay of the laparoscopic group were significantly different (P < 0.05). Postoperative complications rate of the laparoscopic group was significantly lower than that of the open group (P < 0.05). One and 3-day WBC, PCT and CRP after surgery increased obviously in both the two groups. The above three indicators on the fifth day after surgery were not significantly different from those before the surgery in the laparoscopic group (P > 0.05), while they were significantly different from those before the surgery in the open group (P < 0.05). Conclusions Compared with open perforation repair, laparoscopic perforation repair surgery is superior for its better surgical effects, fewer postoperative complications and lighter inflammatory response. It is a safe, effective and minimally-invasive treatment for gastroduodenal perforation.

Citation： ZhaoYuanxun, ZhangGuangquan, WuXianlin. Efficacy of Laparoscopic Repair for Gastroduodenal Perforation. West China Medical Journal, 2016, 31(8): 1352-1355. doi: 10.7507/1002-0179.201600369 Copy

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13.	吳階平, 裘法祖.黃家駟外科學[M]. 6版.北京:人民衛生出版社, 2000:1026-1027.
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15.	王浩, 徐丹楓, 劉玉杉, 等. CO₂氣腹對炎癥環境下巨噬細胞功能影響的實驗研究[J].腹腔鏡外科雜志, 2010, 15(4):271-274.

1. Bertleff MJ, Lange JF. Laparoscopic correction of perforated peptic ulcer:first choice? A review of literature[J]. Surg Endosc, 2010, 24(6):1231-1239.
2. 張啟瑜, 汪建平, 鄭樹森, 等.錢禮腹部外科學[M].北京:人民衛生出版社, 2006:161-169.
3. 周麗雅, 崔榮麗.幽門螺桿菌與胃癌[J].中華消化雜志, 2010, 30(7):497-499.
4. 吳勇.腹腔鏡胃十二指腸潰瘍穿孔修補術的臨床研究[J].四川醫學, 2012, 33(6):1050-1052.
5. Yang XX, Shi HP, Hou LB. Chinese medicine compound Changtong oral liquid on postoperative intestinal adhesions[J]. World J Gastroenterol, 2005, 11(19):2967-2970.
6. 何瑞龍, 張利宏, 黃堅雄, 等.腹腔鏡與開腹胃十二指腸潰瘍穿孔修補術后并發癥的對比研究[J].腹腔鏡外科雜志, 2012, 17(9):674-676.
7. Lee SW, Whelan RL. Immunologic and oncologic implications of laparoscopic surgery:what is the latest?[J]. Clin Colon Rectal Surg, 2006, 19(1):5-12.
8. 李國新, 趙保玉.腹腔鏡胃腸手術與腸粘連形成[J].腹腔鏡外科雜志, 2010, 15(6):404-410.
9. 趙青川, 豐帆.解剖學微創向功能學微創的轉變[J].中華消化外科雜志, 2012, 11(1):35-37.
10. 孫克新, 惠遠見.腹腔鏡手術治療消化性潰瘍穿孔對機體炎癥反應及免疫功能的影響[J].臨床外科雜志, 2014, 22(4):288-290.
11. Dutta S, Fullarton GM, Forshaw MJ, et al. Persistent elevation of C-reactive protein following esophagogastric cancer resection as a predictor of postoperative surgical site infectious complications[J]. World J Surg, 2011, 35(5):1017-1025.
12. Sylla P, Nihalani A, Whelan RL. Microarray analysis of the differential effects of open and laparoscopic surgery on murine splenic T-cells[J]. Surgery, 2006, 139(1):92-103.
13. 吳階平, 裘法祖.黃家駟外科學[M]. 6版.北京:人民衛生出版社, 2000:1026-1027.
14. 門學博, 韓恩昆, 杜慶云.胃十二指腸潰瘍急性穿孔手術時機和手術方式探討[J].實用臨床醫學, 2004, 5(2):36-38.
15. 王浩, 徐丹楓, 劉玉杉, 等. CO₂氣腹對炎癥環境下巨噬細胞功能影響的實驗研究[J].腹腔鏡外科雜志, 2010, 15(4):271-274.

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