| 摘要 |
Laparoscopic cholecystectomy is already widely accepted as a routine treatment for gallbladder disease. Surgeons have become expert in the use of the laparoscope, and are now able to apply this technique to a wide variety of gastrointestinal problems. In 1995, laparoscopic truncal vagotomy was performed here in 5 out of 56 patients who received surgical treatment for their complicated peptic ulcer disease. The indications for surgery were perforation, hemorrhage, stenosis and intractability in 33, 10, 10 and 3 patients, respectively. The indication for the five patients who received laparoscopic vagotomy was stenosis in four and intractability in one patient with recurrent marginal ulcer. All patients except the patient with marginal ulcer received a drainage procedure in addition to truncal vagtomy. One patient received laparoscopic antrectomy and BIi anastomosis and one received laparoscopic gastrojejunostomy. The other two patients received drainage procedure through minimidline laparotomy-one with Finney pyloroplasty and one with gastrojejunustomy. For 5 laparoscopic vagotomy patients, the operation time ranged from 40 to 380 minutes. A major complication of anastomotic leakage occurred in the patient who received laparoscopic antrectomy. The patient received laparotomy, and was discharged after hospitalization for 40 days. The other four patients had rapid recover, and were discharged t~o to six post-surgery days. After a follow-up of one to six months, all the patients were well, without either medication or recurrence of symptoms. In conclusion, laparoscopic truncal vagotomy can be a safe, feasible and efficient procedure for elective peptic ulcer surgery. Combined laparoscopic truncal vagotomy and minilaparotomy for drainage procedure are recommended as the preferred choice for simplicity and economy. |
