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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Abstract Full text Figures/Tables Video References Cited by

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.	吴阶平, 裘法祖.黄家驷外科学[M]. 6版.北京:人民卫生出版社, 2000:1026-1027.
14.	门学博, 韩恩昆, 杜庆云.胃十二指肠溃疡急性穿孔手术时机和手术方式探讨[J].实用临床医学, 2004, 5(2):36-38.
15.	王浩, 徐丹枫, 刘玉杉, 等. CO₂气腹对炎症环境下巨噬细胞功能影响的实验研究[J].腹腔镜外科杂志, 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. 张启瑜, 汪建平, 郑树森, 等.钱礼腹部外科学[M].北京:人民卫生出版社, 2006:161-169.
3. 周丽雅, 崔荣丽.幽门螺杆菌与胃癌[J].中华消化杂志, 2010, 30(7):497-499.
4. 吴勇.腹腔镜胃十二指肠溃疡穿孔修补术的临床研究[J].四川医学, 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. 何瑞龙, 张利宏, 黄坚雄, 等.腹腔镜与开腹胃十二指肠溃疡穿孔修补术后并发症的对比研究[J].腹腔镜外科杂志, 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. 李国新, 赵保玉.腹腔镜胃肠手术与肠粘连形成[J].腹腔镜外科杂志, 2010, 15(6):404-410.
9. 赵青川, 丰帆.解剖学微创向功能学微创的转变[J].中华消化外科杂志, 2012, 11(1):35-37.
10. 孙克新, 惠远见.腹腔镜手术治疗消化性溃疡穿孔对机体炎症反应及免疫功能的影响[J].临床外科杂志, 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. 吴阶平, 裘法祖.黄家驷外科学[M]. 6版.北京:人民卫生出版社, 2000:1026-1027.
14. 门学博, 韩恩昆, 杜庆云.胃十二指肠溃疡急性穿孔手术时机和手术方式探讨[J].实用临床医学, 2004, 5(2):36-38.
15. 王浩, 徐丹枫, 刘玉杉, 等. CO₂气腹对炎症环境下巨噬细胞功能影响的实验研究[J].腹腔镜外科杂志, 2010, 15(4):271-274.

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