穿孔性消化性溃疡的手术:腹腔镜手术是一个新的范例吗?

IF 1.3 Q3 SURGERY
Minimally Invasive Surgery Pub Date : 2021-05-12 eCollection Date: 2021-01-01 DOI:10.1155/2021/8828091
André Pereira, Hugo Santos Sousa, Diana Gonçalves, Eduardo Lima da Costa, André Costa Pinho, Elisabete Barbosa, José Barbosa
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引用次数: 9

摘要

腹腔镜修复穿孔性消化性溃疡(PPU)仍存在争议,主要是由于其在危重患者中的安全性和适用性。本研究的目的是比较腹腔镜与开腹手术治疗PPU的效果。方法:对2012年至2019年接受手术修复PPU的所有患者进行单机构回顾性研究。结果:在研究期间,169例患者因PPU接受了紧急手术。60例患者尝试腹腔镜入路,其中49例完全手术(转换率18.3%)。开放组120例(包括11例转诊)。腹腔镜组与开放组比较,性别差异有统计学意义(男女比例分别为7.2/1和2.2/1;P =0.009)和存在脓毒症标准时(分别为12.2%对38.3%;p=0.001),而Boey评分在两组间无差异。腹腔镜组手术时间更长(中位100' vs 80', p=0.01)。腹腔镜术后早期并发症少(18.4%比41.7%,p=0.004),死亡率低(2.0%比14.2%;P =0.02)、更短的住院时间(中位数为6天对7天,P =0.001)和更早的口服摄入(中位数为3天对4天,P =0.021)。结论:如果有专业知识和资源,腹腔镜下PPU修复可以被认为是没有脓毒症标准的患者的首选手术。这种方法与较短的住院时间和较早的口服摄入有关。对于符合脓毒症标准的患者,需要更多的数据来验证腹腔镜治疗PPU的安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgery for Perforated Peptic Ulcer: Is Laparoscopy a New Paradigm?

Introduction: Laparoscopic repair of perforated peptic ulcer (PPU) remains controversial mainly due to its safety and applicability in critically ill patients. The aim of this study is to compare the outcomes of laparoscopy versus laparotomy in the treatment of PPU.

Methods: Single-institutional, retrospective study of all patients submitted to surgical repair of PPU between 2012 and 2019.

Results: During the study period, 169 patients underwent emergent surgery for PPU. A laparoscopic approach was tried in 60 patients and completely performed in 49 of them (conversion rate 18.3%). The open group was composed of 120 patients (included 11 conversions). Comparing the laparoscopic with the open group, there were significant differences in gender (male/female ratio 7.2/1 versus 2.2/1, respectively; p=0.009) and in the presence of sepsis criteria (12.2% versus 38.3%, respectively; p=0.001), while the Boey score showed no differences between the two groups. The operative time was longer in the laparoscopic group (median 100' versus 80', p=0.01). Laparoscopy was associated with few early postoperative complications (18.4% versus 41.7%, p=0.004), mortality (2.0% versus 14.2%; p=0.02), shorter hospital stay (median 6 versus 7 days, p=0.001), and earlier oral intake (median 3 versus 4 days, p=0.021).

Conclusion: Laparoscopic repair of PPU may be considered the procedure of choice in patients without sepsis criteria if expertise and resources are available. This kind of approach is associated with a shorter length of hospital stay and earlier oral intake. In patients with sepsis criteria, more data are required to access the safety of laparoscopy in the treatment of PPU.

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CiteScore
3.00
自引率
0.00%
发文量
8
审稿时长
16 weeks
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