ABSTRACT
Objective To compare the clinical efficacy of three-dimensional (3D) and two-dimensional (2D) laparoscopic repairs of gastroduodenal perforation.Methods The retrospective cohort study was conducted.The clinicopathological data of 92 patients who underwent laparoscppic repair of gastroduodenal perforation from July 2014 to December 2017 in the Ganzhou People's Hospital were collected.Forty-four patients undergoing 3D laparoscopic repair and 48 patients undergoing 2D laparoscopic repair were respectively allocated into the 3D and 2D groups.Observation indicators:(1) comparisons of intra-and post-operative recovery;(2) postoperative drug sensitivity test and pathological examination;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect complications after discharging from hospital up to August 2018.Measurement data with normal distribution were represented as x-±s and comparison between groups was analyzed using t test.Measurement data with skewed distribution were described as M (range).Comparison between groups of count data was analyzed using the chi-square test.Results (1) Comparison of intra-and post-operative recovery:92 patients underwent successfully laparoscopic gastroduodenal perforation,without conversion to open surgery or perioperative death.The operation time,time of pathological tissue extract at the perforation,time of perforation repair,volume of intraoperative blood loss and time of initial anal exsufflation were respectively (60± 8)minutes,(36± 6) seconds,(137±12)seconds,(9.0±2.2)mL,(23.8±2.8)hours in the 3D group and (70±9)minutes,(39±6) seconds,(143±14) seconds,(10.3±2.5) mL,(25.9±4.8) hours in the 2D group,with statistically significant differences between groups (t =5.795,2.779,2.215,7.740,2.570,P＜0.05).Three patients in the 3D group were complicated with pulmonary infection,localized atelectasis and delirium.Two patients in the 2D group were complicated with pulmonary infection and heart failure.Patients with complications between groups were improved by symptomatic and supporting treatment.There was no statistically significant difference in cases with postoperative complications between groups (x2 =0.010,P＞ 0.05).(2) Postoperative drug sensitivity test and pathological examination:the ascites culture of peritoneal effusion in the 2 groups was positive,and drug susceptibility results were obtained.No malignant cells at the perforation were found in pathological examination.(3) Follow-up:84 patients were followed up for 1-12 months,with a median time of 3 months.There was no related complication after discharging from hospital.Conclusion Compared with 2D laparoscopic repair of gastroduodenal perforation,3D laparoscopic repair of gastroduodenal perforation not only is safe and feasible,but also has advantages of shorter operation time,perforation repair time and time of pathological tissue extract at the perforation,less volume of intraoperative blood loss and shorter time of initial anal exsufflation.