本文選題：膿苔 + 分級(jí)　； 參考：《實(shí)用醫(yī)學(xué)雜志》2017年14期

【摘要】：目的研究消化性潰瘍穿孔(perforated peptic ulcers,PPUs)后腹腔內(nèi)不同粘附度的膿苔對(duì)開腹修補(bǔ)(open repair,OR)和腹腔鏡穿孔修補(bǔ)術(shù)(laparoscopic repair,LR)治療效果的影響。方法將盆腔內(nèi)膿苔粘附度分為一、二、三級(jí),分別對(duì)比這三種級(jí)別膿苔粘附度對(duì)應(yīng)的OR和LR手術(shù)時(shí)間、腹腔引流量、切口愈合異常率、首次排便或者排氣時(shí)間、下床活動(dòng)時(shí)間、住院天數(shù)、轉(zhuǎn)入ICU例數(shù)、術(shù)后放棄治療率等。結(jié)果 OR組膿苔粘附度一級(jí)78例,二級(jí)46例,三級(jí)29例;LR組膿苔粘附度一級(jí)71例,二級(jí)39例,三級(jí)15例。膿苔一級(jí)中,LR組除術(shù)后放棄治療率與OR組相比無差異外(P值為0.209),在手術(shù)時(shí)間、腹腔引流量、切口愈合異常率、腸功能恢復(fù)時(shí)間、下床活動(dòng)時(shí)間、住院天數(shù)、轉(zhuǎn)入ICU例數(shù)均要小于OR組(P值分別為0.000、0.000、0.015、0.000、0.000、0.000、0.043)。膿苔二級(jí)中,LR與OR組對(duì)比在手術(shù)時(shí)間、術(shù)后放棄治療率方面差別不顯著外(P值分別0.196、0.358),在腹腔引流量、切口愈合異常率、腸功能恢復(fù)時(shí)間、下床活動(dòng)時(shí)間、住院天數(shù)、轉(zhuǎn)入ICU例數(shù)、均小于OR組(P值分別為0.000、0.033、0.000、0.000、0.001、0.028)。在膿苔三級(jí)患者,LR在手術(shù)時(shí)間、腹腔引流量、住院時(shí)間方面大于開腹組(P0.05),在腸功能恢復(fù)時(shí)間、切口異常愈合發(fā)生率、下床活動(dòng)時(shí)間、轉(zhuǎn)ICU例數(shù)、術(shù)后放棄治療率方面與OR組比較差異不顯著(P值分別為0.003、0.024、0.002)。結(jié)論一級(jí)膿苔情況下LR明顯優(yōu)于開腹手術(shù);二級(jí)膿苔情況下,LR相對(duì)于開腹仍有諸多優(yōu)勢(shì);三級(jí)膿苔情況下LR有可能劣于OR手術(shù)。
[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 鹵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.
【作者單位】： 遵義醫(yī)學(xué)院附屬醫(yī)院胃腸外科;
【分類號(hào)】：R656.62

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