脓苔粘附度对消化性溃疡穿孔不同手术方式疗效的影响

发布时间：2018-06-26 14:31

本文选题：脓苔 + 分级　；参考：《实用医学杂志》2017年14期

【摘要】：目的研究消化性溃疡穿孔(perforated peptic ulcers,PPUs)后腹腔内不同粘附度的脓苔对开腹修补(open repair,OR)和腹腔镜穿孔修补术(laparoscopic repair,LR)治疗效果的影响。方法将盆腔内脓苔粘附度分为一、二、三级,分别对比这三种级别脓苔粘附度对应的OR和LR手术时间、腹腔引流量、切口愈合异常率、首次排便或者排气时间、下床活动时间、住院天数、转入ICU例数、术后放弃治疗率等。结果 OR组脓苔粘附度一级78例,二级46例,三级29例;LR组脓苔粘附度一级71例,二级39例,三级15例。脓苔一级中,LR组除术后放弃治疗率与OR组相比无差异外(P值为0.209),在手术时间、腹腔引流量、切口愈合异常率、肠功能恢复时间、下床活动时间、住院天数、转入ICU例数均要小于OR组(P值分别为0.000、0.000、0.015、0.000、0.000、0.000、0.043)。脓苔二级中,LR与OR组对比在手术时间、术后放弃治疗率方面差别不显著外(P值分别0.196、0.358),在腹腔引流量、切口愈合异常率、肠功能恢复时间、下床活动时间、住院天数、转入ICU例数、均小于OR组(P值分别为0.000、0.033、0.000、0.000、0.001、0.028)。在脓苔三级患者,LR在手术时间、腹腔引流量、住院时间方面大于开腹组(P0.05),在肠功能恢复时间、切口异常愈合发生率、下床活动时间、转ICU例数、术后放弃治疗率方面与OR组比较差异不显著(P值分别为0.003、0.024、0.002)。结论一级脓苔情况下LR明显优于开腹手术;二级脓苔情况下,LR相对于开腹仍有诸多优势;三级脓苔情况下LR有可能劣于OR手术。
[Abstract]:Objective to study the effect of different adhesions of purulent fur in abdominal cavity after peptic ulcer perforation (perforated peptic ulcerus) on the effect of open repairmoplasty (open repairor) and laparoscopic perforation repair (laparoscopic repairlol LR) in the treatment of peptic ulcer perforation. Methods the adherent degree of pelvic pus fur was divided into one, two and three grades. The OR and LR operative time, abdominal drainage flow, abnormal rate of wound healing, first defecation or exhaust time, time of getting out of bed, and time of getting out of bed were respectively compared with these three grades. The days of hospitalization, the number of cases transferred to ICU, the rate of giving up treatment after operation and so on. Results in OR group, there were 78 cases of grade 1, 46 cases of second grade, 71 cases of grade 1, 39 cases of grade 2 and 15 cases of grade 3 in OR group. There was no significant difference in the rate of abandonment of treatment between the two groups (P = 0.209). The abnormal rate of incision healing, the recovery time of intestinal function, the time of getting out of bed and the days of hospitalization were found in the operation time, abdominal drainage flow rate, wound healing rate, the recovery time of intestinal function, the time of getting out of bed, and the days of hospitalization. The number of cases transferred to ICU was lower than that of OR group (P = 0.000 ~ 0.000 ~ 0.0150.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.043). There was no significant difference in the operative time and the rate of abandoning treatment between the two groups (P = 0.196 ~ 0.358), the drainage of abdominal cavity, the abnormal rate of wound healing, the recovery time of intestinal function, the time of getting out of bed and the days of hospitalization. The number of cases transferred to ICU was less than that of OR group (P = 0.000 ~ 0.033 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.001 ~ 0.028). The time of operation, drainage of abdominal cavity and hospitalization time of the third grade patients with purulent moss were larger than that of the open group (P0.05), the recovery time of intestinal function, the incidence of abnormal healing of incision, the time of getting out of bed, the number of cases transferred to ICU, and the number of patients transferred to ICU. There was no significant difference in the rate of abandonment between the two groups (P = 0.003 0. 024 卤0. 002). Conclusion LR in the case of first-degree purulent moss is superior to that in laparotomy, in the case of secondary purulent moss there are still many advantages over that in laparotomy, and in the case of third-grade purulent moss, LR may be inferior to OR operation.
【作者单位】：遵义医学院附属医院胃肠外科;
【分类号】：R656.62

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