- 期刊
The Assessment of Laparoscope-based Repair for Perforated Peptic Ulcer
腹腔鏡縫合術對於穿孔性消化潰瘍之處理
摘要
由於治療消化性潰瘍藥物的進展，以單純的穿孔縫合術來處理穿孔性消化潰瘍，已被大多醫生所接受。隨著腹腔鏡的發展，以腹腔鏡縫合術處理穿孔性消化潰瘍和傳統開腹手術比較，不外乎傷口小、術後所需止痛藥較少，及術後傷口感染較少等好處。本研究目的為評估腹腔鏡縫合術對於穿孔性消化潰瘍處理是否安全及可行。 從1999年3月至2001年9月間，因消化性潰瘍穿孔於本院接受腹腔鏡消化性潰瘍穿孔縫合術的病人，依其年齡、性別、身體狀況、症狀發作至手術的時間，之前是否有消化性潰瘍的症狀，或是有服用非類固醇類的止痛劑，術後的潰瘍穿孔處、手術者、併發症、改為剖腹術的原因、手術時間、術後住院天數、用止痛藥次數來做統計分析。 共31位病人接受腹腔鏡手術，19% (6/31) 病人有延遲手術的情形，6.4% (2/31) 病人需改為剖腹手術，6.4% (2/31)病人有手術併發症，無人死亡。17位為十二指腸潰瘍穿孔，14位胃潰瘍穿孔，平均手術時間為121.5±47.6分鐘，平均術後進食天數為6.4±0.7天，術後住院天數8.8±1.4天。 腹腔鏡縫合術處理穿孔性消化潰瘍，對於特定的病人包含：無嚴重身體疾病、 術前無嚴重休克的病人是安全可行的，並且有令人滿意的結果。至於此手術的限制及益處，尚需更多前瞻性及隨機性的研究。
關鍵字
無資料並列摘要
Background: Since new effective medications for peptic ulcer were developed, simple closure of perforated peptic ulcer has been advocated by many surgeons. The aim of this study is to evaluate the safety and efficacy of laparoscope-based simple closure of perforated peptic ulcer. Methods: A total of 31 patients with perforated peptic ulcer were treated by laparoscope-based simple closure of perforation in Kaohsiung Veterans General Hospital between March 1999 and September 2001. The medical records were analyzed retrospectively. Results: Six patients (19%) received operation for more than 24 hours after perforation. Two patients (6.4%) were further treated with laparotomy. The complication rate was about 6.4% (2/31) and no mortality was noted. The perforation sites were located at duodenum in 17 patients and at stomach in 14 patients. Mean operation time was about 121.5±47.6 minutes. Mean time to resume oral intake was 6.4±0.7 days. Mean post-operative hospital stay was 8.8±1.4 days. Conclusions: Laparoscope-based repair of perforated peptic ulcer is found to be very effective and safe in selective patients without major morbidity. In addition, no severe preoperative shock was noted. However, its limitation and efficacy need to be further investigated in randomized prospective studies.