传统开腹手术及腹腔镜手术治疗老年上消化道穿孔的临床对比研究
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摘要
目的:对比开腹手术及腹腔镜手术治疗老年上消化道穿孔的临床效果。方法:选取2017年2月-2018年1月来本院消化内科接受治疗的老年上消化道穿孔患者62例作为研究对象,根据不同的治疗方式将其分为对照组和观察组,各31例。对照组采用传统的开腹手术治疗,观察组采用腹腔镜手术治疗,观察对比两组的手术指标、术后并发症发生情况以及对治疗的满意程度。结果:观察组手术时间明显长于对照组,切口长度明显短于对照组,术中出血量明显少于对照组,差异均有统计学意义(P<0.05)。观察组术后镇痛及住院时间均明显短于对照组,术后肛门排气时间明显早于对照组,差异均有统计学意义(P<0.05)。观察组术后并发症发生率明显低于对照组,差异有统计学意义(x~2=8.093,P=0.025)。观察组对治疗的总满意度为96.77%明显高于对照组的54.84%,差异有统计学意义(x~2=7.664,P=0.033)。结论:对老年上消化道穿孔患者采用腹腔镜手术治疗可以明显地缩短切口长度、住院以及术后镇痛时间,加快患者的肛门排气速度,减少在手术中的出血量,同时还可以降低患者在术后并发症的发生率,因此在临床上应大力推广。
Objective:To compare the clinical effect of laparotomy and laparoscopic surgery in the treatment of elderly patients with upper gastrointestinal tract perforation.Method:A total of 62 elderly patients with upper gastrointestinal tract perforation treated in the Gastrointestinal Medicine Department of our hospital from February 2017 to January 2018 were selected as the research objects.According to different treatment methods,they were divided into control group and observation group,31 cases in each group.The control group was treated with traditional laparotomy,the observation group was treated with laparoscopic surgery.The surgical indicators,occurrence of postoperative complications and satisfaction with treatment between the two groups were observed and compared.Result:The operation time of the observation group was significantly longer than that of the control group,the incision length was significantly shorter than that of the control group,the amount of intraoperative bleeding was significantly less than that of the control group,the differences were statistically significant(P<0.05).The time of postoperative analgesia and hospitalization in the observation group were significantly shorter than those in the control group,the time of postoperative anal exhaust was significantly earlier than that in the control group,the differences were statistically significant(P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group,the difference was statistically significant( x~2=8.093,P=0.025).The total satisfaction degree with treatment of the observation group was 96.77%,which was significantly higher than 54.84% of the control group,the difference was statistically significant( x~2=7.664,P=0.033).Conclusion:Laparoscopic surgery in the treatment of elderly patients with upper gastrointestinal tract perforation can significantly shorten the length of incision,hospitalization and postoperative analgesia time,accelerate the speed of anal exhaust,reduce the amount of intraoperative bleeding and also reduce the incidence of postoperative complications at the same time.Therefore,it should be vigorously promoted in clinical practice.
Objective:To compare the clinical effect of laparotomy and laparoscopic surgery in the treatment of elderly patients with upper gastrointestinal tract perforation.Method:A total of 62 elderly patients with upper gastrointestinal tract perforation treated in the Gastrointestinal Medicine Department of our hospital from February 2017 to January 2018 were selected as the research objects.According to different treatment methods,they were divided into control group and observation group,31 cases in each group.The control group was treated with traditional laparotomy,the observation group was treated with laparoscopic surgery.The surgical indicators,occurrence of postoperative complications and satisfaction with treatment between the two groups were observed and compared.Result:The operation time of the observation group was significantly longer than that of the control group,the incision length was significantly shorter than that of the control group,the amount of intraoperative bleeding was significantly less than that of the control group,the differences were statistically significant(P<0.05).The time of postoperative analgesia and hospitalization in the observation group were significantly shorter than those in the control group,the time of postoperative anal exhaust was significantly earlier than that in the control group,the differences were statistically significant(P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group,the difference was statistically significant( x~2=8.093,P=0.025).The total satisfaction degree with treatment of the observation group was 96.77%,which was significantly higher than 54.84% of the control group,the difference was statistically significant( x~2=7.664,P=0.033).Conclusion:Laparoscopic surgery in the treatment of elderly patients with upper gastrointestinal tract perforation can significantly shorten the length of incision,hospitalization and postoperative analgesia time,accelerate the speed of anal exhaust,reduce the amount of intraoperative bleeding and also reduce the incidence of postoperative complications at the same time.Therefore,it should be vigorously promoted in clinical practice.
引文
[1]曹海霞.32例保守治疗上消化道穿孔患者的护理[J].中国卫生标准管理,2016,7(8):250-252.
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[12]赵鲁文,于爱军,张玉娟,等.腹腔镜和开腹手术治疗中国老年卵巢良性肿瘤疗效的Meta分析[J].现代预防医学,2015,42(9):1722-1726.
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[14]李秀文.三联疗法+双歧杆菌三联活菌胶囊治疗幽门螺旋杆菌消化性溃疡疗效观察[J].基层医学论坛,2017,21(1):12-14.
[15]谢晓云.曾志伟.双歧杆菌三联活菌胶囊对Hp相关性胃炎患者的疗效及炎症因子的影响[J].中国卫生工程学,2017,16(4):138-139,141.
[16]陈燕.王振宇.双歧杆菌三联活菌联合三联疗法对治疗慢性胃炎的临床疗效观察[J].中国继续医学教育,2017,9(10):171-172.
[17]李文翔,杨雷,李巍,等.传统开腹手术与腹腔镜治疗老年上消化道穿孔疗效分析[J].淮海医药,2017,35(2):195-196.
[18]王天培.两种修补手术方式治疗老年上消化道穿孔术后并发症及预后临床对比分析[J].医学理论与实践,2015,28(11):1470-1471.
[19]杨茂祥.开腹与腹腔镜修补术治疗老年上消化道穿孔的临床疗效比较[J].医学理论与实践,2015,28(12):1604-1605.
[20]麦昌文,陈代忠,刘抒怀.腹腔镜与开腹上消化道溃疡穿孔修补术的疗效研究[J].中国医药科学,2015,5(6):141-143.
[2]马小会.68例老年上消化道穿孔患者围手术期护理体会[J].吉林医学,2015,36(3):535-536.
[3]邓洪飞.泮托拉唑治疗消化性溃疡临床疗效观察[J].世界最新医学信息文摘,2017,17(75):93-94.
[4]蒋志进.胃乐宁联合泮托拉唑治疗消化性溃疡并发出血56例的临床效果[J].现代诊断与治疗,2016,27(20):3871-3872.
[5]周红燕.三联疗法联合双歧杆菌治疗幽门螺杆菌阳性慢性胃病的疗效观察[J].现代消化及介入诊疗,2016,21(2):282-284.
[6]邓玉华,董耀兵,沈旺英.双歧杆菌三联活菌胶囊联合标准三联疗法或四联疗法治疗幽门螺旋杆菌感染性消化性溃疡的疗效研究[J].临床合理用药,2015,8(7C):21-23.
[7]周南南.急性上消化道穿孔行保守治疗80例效果观察及护理[J].齐鲁护理杂志,2016,22(9):89-90.
[8]皮健.上消化道穿孔手术的护理及并发症观察[J/OL].临床医药文献电子杂志,2015,2(9):1727-1728.
[9]张荣花.不同护理模式在老年急性胃穿孔患者中的护理效果观察[J].医学理论与实践,2016,29(13):1790-1791.
[10]徐茂国,程家平.外科治疗老年患者上消化道急性穿孔的临床体会[J].深圳中西医结合杂志,2015,27(3):117-119.
[11]饶灿,邱雪芝.综合护理模式应用于上消化道穿孔老年患者围手术期的效果探究[J].中外医学研究,2017,15(35):83-84.
[12]赵鲁文,于爱军,张玉娟,等.腹腔镜和开腹手术治疗中国老年卵巢良性肿瘤疗效的Meta分析[J].现代预防医学,2015,42(9):1722-1726.
[13]唐豪.腹腔镜手术与传统开腹手术治疗上消化道溃疡穿孔的临床效果比较[J].临床合理用药,2017,10(2A):28-29.
[14]李秀文.三联疗法+双歧杆菌三联活菌胶囊治疗幽门螺旋杆菌消化性溃疡疗效观察[J].基层医学论坛,2017,21(1):12-14.
[15]谢晓云.曾志伟.双歧杆菌三联活菌胶囊对Hp相关性胃炎患者的疗效及炎症因子的影响[J].中国卫生工程学,2017,16(4):138-139,141.
[16]陈燕.王振宇.双歧杆菌三联活菌联合三联疗法对治疗慢性胃炎的临床疗效观察[J].中国继续医学教育,2017,9(10):171-172.
[17]李文翔,杨雷,李巍,等.传统开腹手术与腹腔镜治疗老年上消化道穿孔疗效分析[J].淮海医药,2017,35(2):195-196.
[18]王天培.两种修补手术方式治疗老年上消化道穿孔术后并发症及预后临床对比分析[J].医学理论与实践,2015,28(11):1470-1471.
[19]杨茂祥.开腹与腹腔镜修补术治疗老年上消化道穿孔的临床疗效比较[J].医学理论与实践,2015,28(12):1604-1605.
[20]麦昌文,陈代忠,刘抒怀.腹腔镜与开腹上消化道溃疡穿孔修补术的疗效研究[J].中国医药科学,2015,5(6):141-143.