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目的 比较腹腔镜和开腹手术治疗急性消化性溃疡穿孔的临床疗效及预后.方法急性消化性溃疡穿孔患者120例,采用随机数字表法将120例患者随机分为腹腔镜组(60例)和开腹组(60例),比较两组患者手术时间、术中出血量、术后肛门排气时间、术后使用镇痛药物次数、术后住院时间、住院总费用及术后并发症发生率等指标.结果开腹组和腹腔镜组术中出血分别为(8.9±1.8)ml和(25.8±5.3)ml,术后肛门排气时间分别为(41.5±12.2)小时和(59.2±16.3)小时,镇痛例数分别为5例(8.33%)和26例(43.33%),术后切口感染发生率分别为0(0例)和8.3%(5例),住院时间分别为(6.92±1.27)天和(9.63±2.01)天,两组比较差异均有统计学意义(P0.05).随访2~6个月,两组均无再次穿孔及死亡患者.结论腹腔镜手术治疗急性消化性溃疡穿孔安全有效,出血少、恢复快、疼痛轻、并发症少、住院时间短.“,”Objective To evaluate the differences of clinical effects and prognosis between lapa-roscopic and laparotomy in treatment of acute perforated peptic ulcer.Methods 120 patients with a clini-cal diagnosis of perforated peptic ulcer were randomly assigned to either laparoscopic (n =60)or open (n =60)surgery.Two groups were comparared in operative time,operative bleeding,postoperative anal ex-haust time,rate of use analgesics,length of postoperative hospital stay,inpatients expenses and postopera-tive morbidity.Results The operative bleeding and postoperative anal exhaust time in laparoscopic group were significantly less than those in the open group [(8.9 ±1.8)ml vs(25.8 ±5.3)ml,[(41.5 ±12.2) h vs(59.2 ±16.3)h,both P <0.05].After surgery laparoscopic group required significantly less paren-teral analgesics than those who underwent laparotomy [5 (8.33%)vs 26(43.33%),P <0.05].There were fewer incision infections in laparoscopic group than those in the open group[0(0)vs 5(8.3%),P <0.05].There were significant differences in length of postoperative hospital stay[(6.92 ±1.27)d vs (9.63 ±2.01)d,P 0.05).The patients were followed up for 2 ~6 months,during which there were no patients undergoing re-perforation or fatal complications in both groups.Conclusion Repair of perforated peptic ulcer with laparoscopy is a safe and effective method.It is associated with less bleeding,short post-operative anal exhaust time,less postoperative pain,low occurrence rate of complication,short hospitaliza-tion time and etc,which is the ideal operation method to treat acute perforated peptic ulcer.