Objective To study the effects of intraperitoneal adherence of pus mosses on the efficacy of open repair(OR)and laparoscopic repair(LR)for perforated peptic ulcers(PPUs). Methods Intraperitonealad-herence of pus mosses was divided into the first,second and third stage,respectively. Surgical duration,volume of peritoneal drainage ,rate of abnormal wound healing ,number of intensive care unit transfer ,recovery time of bowel function ,ambulation time ,length of hospital stay ,and postoperative treatment abandonment rate were compared. Results There were 78 ,46 ,and 29 patients for the three stages in OR group ,and 71 ,39 ,and 15 patients in LR group,respectively. There were significant differences insurgical duration,volume of peritoneal drainage,rate of abnormalwound healing,number of ICU transfer,recovery time of bowel function,ambulation time,length of hospital stay about the first stage between the two surgical methods(P values were 0.000,0.000, 0.015,0.000,0.000,0.000,and 0.043 respectively)except for treatment abandonment rate(P value was 0.209). There were significant differences in volume of peritoneal drainage ,rate of abnormal wound healing ,number of ICU transfer,recovery time of bowel function,ambulation time,and length of hospital stay(P values were 0.000, 0.033,0.000,0.000,0.001,and 0.028 respectively)for the second stage except surgical duration and treatment abandonment rate(P values were 0.196 and 0.358 respectively) between the two procedures. The differences were significant in surgical duration ,volume of peritoneal drainage ,and length of hospital stay between the two methods (P values were 0.039 ,0.003 ,0.024 ,and 0.002 respectively) for the third stage but there were no significant differencesin rate of abnormal wound healing , number of ICU transfer , recovery time of bowel function ,ambulation time ,and treatment abandonment rate (P values were 0.175 ,0.173 ,0.766 ,and 0.757 respectively). Conclusions LR is superior to OR under the first stage of pus moss and still has advantages under the second stage. However,LR may be inferior to OR under the third stage.%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(P<0.05),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.
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