ABSTRACT
ObjectiveTo evaluate the effect of laparoscope and open repair on treating upper gastrointestinal(UGI) ulcer perforation.MethodsRetrospective analysis was performed in consecutive series of 143 patients undergoing UGI ulcer perforation repairing.Among the total 143 patients,98 cases underwent laparoscope repair(laparoscope group),45 cases were with open repair (open group).The operation methods included either simple interrupted suture or pedicled omental patch.Postoperative management of triple therapy included proton pump inhibitor,β -lactam antibiotics and arilin was conducted.Therapeutic effects were compared between two groups.ResultsOperating time in laparoscope group was significantly longer than that in open group [ ( 83.88 ± 19.67 ) min vs.( 63.33 ± 12.06) min,P ＜ 0.01 ].Time of passage of gas by anus,hospital stay,cost of hospitalization and postoperative dosage of opiates in laparoscope group were significantly lower than those in open group [ (29.45 ± 9.24) h vs.( 46.40 ± 49.21 )h,(6.92 ± 1.06) d vs.(7.71 ± 2.48 ) d,(6929.39 ± 832.40) yuan vs.(7546.67 ± 1393.92) yuan,(5.7 ±8.3 ) mg vs.( 10.9 ± 9.5 ) mg,P＜ 0.01 ].There was no significant difference between two groups in perforated diameter,perforated position and flushing dose of abdominal cavity (P＞ 0.05 ).The rate of complication was 14.29％ (14/98) in laparoscope group,while 26.67％ (12/45) in open group,there was no significant difference between two groups (P＞ 0.05 ).ConclusionsLaparoscope repair of UGI ulcer perforation is a safe and feasible procedure compared with open repair.Although operating time of laparoscope repair is longer than open repair,the rate of complication does not increase.
ABSTRACT
Objective To investigate the clinical manifestation and management of acute cholangitis severe type (ACST) with different typos of obstruction. Methods From January 1997 to December 2006, 164 consecutive patients with ACST had been admitted to Chengdu First People's Hospital. All patients were divided into extrahepatic type group (n=122), intrahepatic type group (n=18) and mixed type group (n=24) accord-ing to the types of obstruction. Clinical manifestation and therapeutic outcome of the 3 groups were analyzed using chi-square test, continuity correction test or Fisher exact test. Results There was no significant difference in clinical manifestation between patients with extrahepatic type and those with mixed type (P>0.05). The incidence of jaundice and abdominal pain in patients with intrahepatic type is significantly lower than those with extrahepatic type (P<0.05). The incidences of distention in consciousness and response to initial medical treat-ment were higher than those with extrahepatic type (P<0.05). The total mortality rate was 9.8% (16/164). Of all patients, 123 received open surgery. There was no significant difference in morbidity and mortality in patients with intrahepatic type and mixed type (χ~2=0.172,0.789; 1.769, 1.948, P>0.05). In emergency operation, the incidence of biliary high pressure and postoperative vital sign improvement rates were significant higher in patients with extrahepatic type than the other 2 types (P<0.05). The morbidity and mortality of patients who received emergency operation were higher than non-emergency operation (P<0.05). Conclusions The clinical manifestation of ACST is different between intrahepatic obstructive type and the other 2 types. There is no signi-ficant difference in morbidity and mortality among the 3 types of obstruction. The morbidity and mortality are high in patients who received emergency operation. Proper management of surgical timing is helpful in decreasing the morbidity and motality of ACST.