十二指肠溃疡穿孔的腹腔镜外科处理
安东均 张成 王旗 王宏孝
摘 要
目的：探讨应用腹腔镜技术对十二指肠溃疡穿孔诊治的效果。
方法：1995年以来对25例十二指肠溃疡穿孔并发弥漫性腹膜炎患者采用腹腔镜检查明确诊断，并在镜下行穿孔缝合及大网膜覆盖修补术，其中6例同时行壁细胞迷走神经切断术（PCV），术后留置腹腔引流，并用H2受体拮抗剂、质子泵抑制剂或联用抗幽门螺杆菌治疗。
结果：25例患者全部在腹腔镜下完成手术，无手术并发症，平均手术时间55 min，平均住院时间6d，术后随访6～36个月，无溃疡复发。
结论：腹腔镜技术应用于十二指肠溃疡穿孔的治疗，创伤小、痛苦少、并发症低，而且能够获得与开腹手术同样的临床疗效。
关键词
十二指肠溃疡；外科手术；腹腔镜外科
The management of duodenal ulcer with acute perforation by laparoscopic surgery
AN Dongjun，ZHANG Cheng，WANG Qi，et al.Department of laparoscopic surgery，TheSecond People's Hospital of Xianyang，Xianyang 712000.China
ABSTRACT
Objective:To evaluate the long term effects of laparoscopic surgery on duodenal ulcer with acute perforation.
Methods:From 1995，Twenty-five patients with duodenal ulcer perforation and dif-fused peritonitis were diagnosed definitely by TV laparoscopic technique，and the perforations were sutured and repaired by greater omentum under laparoscopy.Six cases of them were performed parietal cell vagotomy simultaneously.After operation the drain was put into abdominal cavity and H2 receptor blocking agent，proton pump inhibiter or plus antihelicabater pylori therapy were used.
Results:All operations of 25 cases were accomplished under laparoscopy.Whatever operative complications had not happened.Average operation times were 55 minutes.The total hospital days were 6 in average.Postoperative follow-up ranged from 0.5～3 years，no duodenal ulcer recurred.
Conclusion:The laparoscopy adopted in treating duodenal ulcer perle-ration is a procedure with minimal invasion and scarceness of postoperative complication；its clinical effectiveness is as good as laparotomized operation.
KEY WORDS
Duodenal ulcer；Surgical operation；Laparoscopic surgery
近年来，随着微创技术的发展，应用腹腔镜行各种选择性迷走神经切断术或穿孔修补术治疗十二指肠溃疡或溃疡穿孔，取得较好的疗效［1］。我院自1995年以来对25例十二指肠球部溃疡穿孔患者施行了腹腔镜手术，现将治疗情况报道如下。