腹腔镜与开腹手术在老年胃溃疡穿孔治疗中的应用效果观察
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摘要
目的观察腹腔镜与开腹手术在老年胃溃疡穿孔治疗中的应用效果。方法选取2015年3月至2017年1月收治的老年胃溃疡穿孔患者98例,按随机数字表法分为对照组与观察组,每组49例。对照组采用开腹手术治疗,观察组采用腹腔镜手术治疗。对比两组手术相关指标、肠胃激素及并发症发生情况。结果观察组的手术时间(91.63±20.63) min较对照组长,术中失血量(36.43±4.42) m L较对照组少,切口长度(4.13±1.07) cm、肠胃功能恢复时间(137.77±9.77) h及住院时间(7.01±1.33) d短于对照组,差异有统计学意义(P<0.05);术后,两组胃动素、促胃液素水平均上升,且与对照组[(115.17±12.26) ng/L、(22.11±6.31) ng/L]相比,观察组的胃动素(136.23±14.43) ng/L、促胃液素(26.07±8.46) ng/L水平更高,差异有统计学意义(P<0.05);观察组并发症总发生率为4.08%,低于对照组的16.33%,差异有统计学意义(P<0.05)。结论腹腔镜修补术治疗老年胃溃疡穿孔较开腹手术更具有优势,其不仅可有效减少患者出血,降低手术创伤程度,且有利于提升患者术后肠胃功能,促进机体恢复,还可减少并发症发生,提升手术治疗效果。
Objective To observe the application effects of laparoscopy and open surgery in the treatment of senile perforation of gastric ulcer.Methods 98 senile patients with perforation of gastric ulcer admitted to hospital from March 2015 to January 2017 were selected,and they were divided into control group and observation group by random number table,with 49 cases in each group.The control group were given open surgery,while the observation group were treated with laparoscopy.And then,surgical indexes,gastrointestinal hormones and complications were compared between the two groups. Results The operation time of the observation group( 91.63±20.63) min was longer than that of the control group,intraoperative bleeding volume( 36.43±4.42) m L was less,and incision length( 4.13±1.07) cm,the recovery time of gastrointestinal function( 137.77±9. 77) h and hospital stays( 7.01±1.33) d in the observation group were shorter than those in the control group,difference was statistically significant( P<0.05).After surgery,the levels of motilin and gastrin in the two groups increased,the motilin( 136.23±14.43) ng/L and gastrin( 26.07±8.46) ng/L in the observation group were higher than those in the control group( 115.17± 12.26,22.11± 6.31)ng/L,difference was statistically significant( P<0.05).The total incidence of complications in the observation group was 4.08%,lower than that( 16.33%) in the control group,difference was statistically significant( P<0.05).Conclusion Laparoscopic repair in the treatment of senile perforation of gastric ulcer has more advantages than open surgery.It not only can reduce bleeding and surgical trauma,but also can enhance postoperative gastrointestinal function,promote the recovery of the body.In addition,it can also reduce the incidence of complications and improve the effect of surgical treatment.
Objective To observe the application effects of laparoscopy and open surgery in the treatment of senile perforation of gastric ulcer.Methods 98 senile patients with perforation of gastric ulcer admitted to hospital from March 2015 to January 2017 were selected,and they were divided into control group and observation group by random number table,with 49 cases in each group.The control group were given open surgery,while the observation group were treated with laparoscopy.And then,surgical indexes,gastrointestinal hormones and complications were compared between the two groups. Results The operation time of the observation group( 91.63±20.63) min was longer than that of the control group,intraoperative bleeding volume( 36.43±4.42) m L was less,and incision length( 4.13±1.07) cm,the recovery time of gastrointestinal function( 137.77±9. 77) h and hospital stays( 7.01±1.33) d in the observation group were shorter than those in the control group,difference was statistically significant( P<0.05).After surgery,the levels of motilin and gastrin in the two groups increased,the motilin( 136.23±14.43) ng/L and gastrin( 26.07±8.46) ng/L in the observation group were higher than those in the control group( 115.17± 12.26,22.11± 6.31)ng/L,difference was statistically significant( P<0.05).The total incidence of complications in the observation group was 4.08%,lower than that( 16.33%) in the control group,difference was statistically significant( P<0.05).Conclusion Laparoscopic repair in the treatment of senile perforation of gastric ulcer has more advantages than open surgery.It not only can reduce bleeding and surgical trauma,but also can enhance postoperative gastrointestinal function,promote the recovery of the body.In addition,it can also reduce the incidence of complications and improve the effect of surgical treatment.
引文
[1]黄小明.腹腔镜胃穿孔修补术的临床效果分析[J].环球中医药,2015,8(S2):169.
[2]周礼,庄文.腹腔镜和开腹手术修补老年人消化性溃疡穿孔的疗效比较[J].华西医学,2015,30(10):1873-1876.
[3]章永峰,胡晓明,王志刚,等.腹腔镜与开腹手术治疗胃穿孔效果对比观察[J].人民军医,2015,58(4):380-381.
[4]张庆鹏,卫勃,陈凛.腹腔镜在65岁以上胃肠外科急腹症患者手术中的应用[J].中华胃肠外科杂志,2015,18(8):797-800.
[5]刘安明.腹腔镜胃十二指肠溃疡穿孔修补术的疗效评价[J].中国现代普通外科进展,2015,18(5):387,402.
[6]朱宗恒,何韵彬,史火喜,等.腹腔镜下治疗胃穿孔手术疗效分析[J].结直肠肛门外科,2016,22(S1):29-30.
[7]张贤坤,刘宏斌,韩晓鹏,等.腹腔镜技术在胃十二指肠穿孔修补术中的应用[J].广东医学,2015,36(2):233-234.
[8]熊为民,邓剑,丁志平,等.腹腔镜辅助小切口与开腹手术治疗老年胃十二指肠溃疡穿孔的比较[J].中国微创外科杂志,2016,16(6):570-572,576.
[9]陶亮,翁晓晖,孔晓武,等.腹腔镜技术在消化道穿孔早期诊断和治疗中的应用体会[J].中国微创外科杂志,2015,15(5):467-469.
[10]侯花屏,冯江,刘新奇,等.腹腔镜下穿孔修补术治疗老年胃溃疡合并胃穿孔的临床观察[J].老年医学与保健,2017,23(6):502-504.
[11]黄树民.腹腔镜修补术与开腹修补术治疗胃穿孔术后胃肠动力恢复情况对比研究[J].临床和实验医学杂志,2016,15(24):2467-2469.
[12]吴世乐,郭亚民,吴新民,等.胃穿孔腹腔镜修补术的手术方法及临床效果观察[J].中国现代普通外科进展,2017,20(4):306-308.
[2]周礼,庄文.腹腔镜和开腹手术修补老年人消化性溃疡穿孔的疗效比较[J].华西医学,2015,30(10):1873-1876.
[3]章永峰,胡晓明,王志刚,等.腹腔镜与开腹手术治疗胃穿孔效果对比观察[J].人民军医,2015,58(4):380-381.
[4]张庆鹏,卫勃,陈凛.腹腔镜在65岁以上胃肠外科急腹症患者手术中的应用[J].中华胃肠外科杂志,2015,18(8):797-800.
[5]刘安明.腹腔镜胃十二指肠溃疡穿孔修补术的疗效评价[J].中国现代普通外科进展,2015,18(5):387,402.
[6]朱宗恒,何韵彬,史火喜,等.腹腔镜下治疗胃穿孔手术疗效分析[J].结直肠肛门外科,2016,22(S1):29-30.
[7]张贤坤,刘宏斌,韩晓鹏,等.腹腔镜技术在胃十二指肠穿孔修补术中的应用[J].广东医学,2015,36(2):233-234.
[8]熊为民,邓剑,丁志平,等.腹腔镜辅助小切口与开腹手术治疗老年胃十二指肠溃疡穿孔的比较[J].中国微创外科杂志,2016,16(6):570-572,576.
[9]陶亮,翁晓晖,孔晓武,等.腹腔镜技术在消化道穿孔早期诊断和治疗中的应用体会[J].中国微创外科杂志,2015,15(5):467-469.
[10]侯花屏,冯江,刘新奇,等.腹腔镜下穿孔修补术治疗老年胃溃疡合并胃穿孔的临床观察[J].老年医学与保健,2017,23(6):502-504.
[11]黄树民.腹腔镜修补术与开腹修补术治疗胃穿孔术后胃肠动力恢复情况对比研究[J].临床和实验医学杂志,2016,15(24):2467-2469.
[12]吴世乐,郭亚民,吴新民,等.胃穿孔腹腔镜修补术的手术方法及临床效果观察[J].中国现代普通外科进展,2017,20(4):306-308.