摘要
目的:探讨腹腔镜胃穿孔修补术后复发的高危因素。方法:回顾分析2015年1月至2018年9月收治的138例行腹腔镜胃穿孔修补术治疗的胃穿孔患者的临床资料,利用单因素与多因素Logistic回归分析腹腔镜胃穿孔修补术后复发的高危因素。结果:138例患者中29例术后复发,复发率为21.01%;单因素分析发现,未复发组与复发组患者溃疡程度、术前穿孔直径、有无腹膜炎、穿孔缝合针数、术中进针出针距穿孔位置差异有统计学意义(P<0.05);多因素Logistic回归分析发现,溃疡程度严重、弥漫性腹膜炎、术前穿孔直径≥0.5 cm、穿孔缝合针数>2针、术中进针出针距离穿孔处<0.5 cm是腹腔镜胃穿孔修补术后复发的独立高危因素(P<0.05)。结论:溃疡程度严重、弥漫性腹膜炎、术前穿孔直径≥0.5 cm、穿孔缝合针数>2针、术中进针出针距离穿孔处<0.5 cm等是腹腔镜胃穿孔修补术后复发的独立危险因素,对符合这些情况的患者,手术时应更加谨慎,避免二次手术,同时术后应不间断服用抗溃疡药物,并于出院后3个月内进行胃镜复查。
Objective:To explore high-risk factors of recurrence after laparoscopic gastric perforation repair.Methods:The clinical data of 138 patients with gastric perforation who underwent laparoscopic gastric perforation repair from Jan.2015 to Sep.2018 were retrospectively analyzed.Univariate and multivariate logistic regression analysis were applied to analyze high-risk factors of recurrence after laparoscopic gastric perforation repair.Results:Among 138 patients,29 cases recurred after gastric perforation repair,and the recurrence rate was 21.01%.Univariate analysis found that there were significant differences in ulceration degree,preoperative perforation diameter,presence or absence of peritonitis,number of perforated sutures,and distance between perforation and hole through which intraoperative needle entering or going out between non-recurrence group and recurrence group(P<0.05).Multivariate logistic regression analysis found that severe ulceration,diffuse peritonitis,preoperative perforation diameter not less than 0.5 cm number of perforated sutures>2 and distance between perforation and needle hole less than 0.5 cm were independent high-risk factors of recurrence after laparoscopic gastric perforation repair(P<0.05).Conclusions:Severe ulceration,diffuse peritonitis,preoperative perforation diameter not less than 0.5 cm number of perforated sutures>2 and distance between perforation and needle hole less than 0.5 cm are independent risk factors of recurrence after laparoscopic gastric perforation repair.For patients who meet these conditions,more care should be taken during surgery to avoid secondary surgery.At the same time,anti-ulcer drugs should be taken continuously after the operation,and gastroscopy should be reviewed within 3 months after discharge.
作者
潘永传
黎殿德
PAN Yong-chuan;LI Dian-de(Department of General Surgery,the People's Hospital of Yangchun,Yangchun 529600,China)
出处
《腹腔镜外科杂志》
2020年第6期417-420,共4页
Journal of Laparoscopic Surgery
