RESUMO
Objective@#To compare the clinical effects of laparoscopic repair and open repair of gastroduodenal ulcer perforation.@*Methods@#Retrospective analysis was performed on 117 patients with perforated gastroduodenal ulcer admitted to Sijing Hospital of Shanghai Songjiang District from October 2005 to February 2018, including 86 males and 31 females. The average age was 35.56 years with a range from 17 to 68 years. Patients were divided into two groups according to different surgical methods: laparoscopic group (n=56) and open group (n=61). Patients in the laparoscopic group were received laparoscopic repair for perforated gastroduodenal ulcer, while patients in the open group received open repair for perforated gastroduodenal ulcer. Comparison of two groups of patients with operation time, intraoperative blood loss, postoperative first anal exhaust time, analgesic utilization rate, length of hospital stay, the body′s inflammatory response [preoperative and 24 h, 72 h, 120 h of postoperative peripheral white blood cell (WBC)], C-reactive protein level (CRP), postoperative complications (postoperative incision infection, incision dehiscence, gastric duodenal fistula, abdominal abscess, adhesion intestinal obstruction and lung infection). Measurement data were expressed as mean±standard deviation (Mean±SD), and t-test was used for comparison between groups; count data were compared by Chi-square test.@*Results@#All the patients in the two groups successfully completed the operation, and there were no cases transferred to laparotomy in the laparoscopic group. Intraoperative blood loss[(15.3±9.5) ml vs (30.5±11.3) ml, P<0.001], time of first anal exhaust[(56.5±9.8) h vs (83.8±15.6) h, P<0.001], analygesic utilization rate (10.71% vs 52.46%, P<0.005), and length of hospital stay [(7.5±1.5) d vs (10.0±3.4) d, P<0.001] of the laparoscopic group were significantly better in the open group, the differences were statistically significant. The WBC and CRP at 24 h, 72 h and 120 h after surgery of the laparoscopic group were also significantly better than in the open group [WBC: 24 h, (14.55±3.44) ×109/L vs (16.02±4.12) ×109/L, P=0.020; 72 h, (10.25±2.32) ×109/L vs (14.22±3.29) ×109/L, P<0.001; 120 h, (8.12±3.11)×109/L vs (11.58±2.33) ×109/L, P<0.001. CRP: 24 h, (50.35±13.73) mg/L vs (80.11±13.56) mg/L, P<0.001; 72 h, (29.37±7.81) mg/L vs (53.57±8.05) mg/L, P<0.001; 120 h, (17.71±7.01) mg/L vs (34.35±7.72) mg/L, P<0.001], the differences were statistically significant. There was no significant difference in operation time and postoperative complications between the two groups (P>0.05).@*Conclusion@#Compared with open gastroduodenal ulcer perforation repair, laparoscopic gastroduodenal ulcer perforation repair surgery trauma are smaller, and the body′s inflammatory response are lighter, postoperative complications is no statistical significance, but will look from actual data, the cases of complications is less, is now a better surgical treatment of gastroduodenal ulcer perforation.
RESUMO
Objective To compare the clinical effects of laparoscopic repair and open repair of gastroduodenal ulcer perforation.Methods Retrospective analysis was performed on 117 patients with perforated gastroduodenal ulcer admitted to Sijing Hospital of Shanghai Songjiang District from October 2005 to February 2018,including 86 males and 31 females.The average age was 35.56 years with a range from 17 to 68 years.Patients were divided into two groups according to different surgical methods:laparoscopic group (n =56) and open group (n =61).Patients in the laparoscopic group were received laparoscopic repair for perforated gastroduodenal ulcer,while patients in the open group received open repair for perforated gastroduodenal ulcer.Comparison of two groups of patients with operation time,intraoperative blood loss,postoperative first anal exhaust time,analgesic utilization rate,length of hospital stay,the body's inflammatory response [preoperative and 24 h,72 h,120 h of postoperative peripheral white blood cell (WBC)],C-reactive protein level (CRP),postoperative complications (postoperative incision infection,incision dehiscence,gastric duodenal fistula,abdominal abscess,adhesion intestinal obstruction and lung infection).Measurement data were expressed as mean ± standard deviation (Mean ± SD),and t-test was used for comparison between groups;count data were compared by Chi-square test.Results All the patients in the two groups successfully completed the operation,and there were no cases transferred to laparotomy in the laparoscopic group.Intraoperative blood loss [(15.3 ± 9.5) ml vs (30.5 ±11.3) ml,P ＜ 0.001],time of first anal exhaust [(56.5 ± 9.8) h vs (83.8 ± 15.6) h,P ＜ 0.001],analygesic utilization rate (10.71％ vs 52.46％,P ＜ 0.005),and length of hospital stay [(7.5 ± 1.5) d vs (10.0 ±3.4) d,P ＜ 0.001] of the laparoscopic group were significantly better in the open group,the differences were statistically significant.The WBC and CRP at 24 h,72 h and 120 h after surgery of the laparoscopic group were also significantly better than in the open group [WBC:24 h,(14.55 ± 3.44) × 109/L vs (16.02 ± 4.12) × 109/ L,P =0.020;72 h,(10.25 ± 2.32) × 109/L vs (14.22 ± 3.29) × 109/L,P ＜ 0.001;120 h,(8.12 ±3.11) ×109/Lvs (11.58 ±2.33) × 109/L,P ＜0.001.CRP:24 h,(50.35 ± 13.73) mg/L vs (80.11 ±13.56) mg/L,P＜0.001;72 h,(29.37 ±7.81) mg/Lvs (53.57 ±8.05)mg/L,P＜0.001;120h,(17.71 ±7.01) mg/L vs (34.35 ± 7.72) mg/L,P ＜ 0.001],the differences were statistically significant.There was no significant difference in operation time and postoperative complications between the two groups (P ＞ 0.05).Conclusion Compared with open gastroduodenal ulcer perforation repair,laparoscopic gastroduodenal ulcer perforation repair surgery trauma are smaller,and the body's inflammatory response are lighter,postoperative complications is no statistical significance,but will look from actual data,the cases of complications is less,is now a better surgical treatment of gastroduodenal ulcer perforation.