评价腹腔镜下胃十二指肠溃疡穿孔修补术的手术效果以及在不同阶段的差异，探讨其学习曲线。

回顾性分析常州市武进人民普通外科2015年10月至2017年12月收治的44例胃十二指肠溃疡穿孔修补术的患者资料，其中男性25例，女性19例；年龄28～78岁，平均(44.2±8.8)岁。将患者按照施行手术方式分为腹腔镜手术组(33例)和开腹手术组(11例，Ⅳ组)。依据进行腹腔镜手术时间早晚，将腹腔镜手术组依次又分为三组(Ⅰ组(2015年10月至2016年9月)，Ⅱ组(2016年10月至2017年5月)，Ⅲ组(2017年6月至2017年12月)，每组11例)。对比各组手术出血量、手术时间、中转开腹率、术后住院时间、术后抗生素时间、住院费用、术后下床活动时间、胃肠功能恢复时间和术后并发症发生率等相关指标，分析不同阶段的手术效果，判断腹腔镜下胃十二指肠穿孔修补术的学习曲线。

腹腔镜成熟组(Ⅲ组)与开腹手术组相比，手术时间[(55.8±10.2)min比(72.3±9.4)min]、术中出血量[(15.1±5.1)mL比(50.7±8.6)mL]、术后抗生素时间[(5.6±0.3)d比(8.2±0.4)d]、下床活动时间[(31.9±1.4)h比(53.8±3.7)h]、术后住院时间[(6.5±0.4)d比(9.3±0.8)d]、胃肠活动时间[(3.5±0.4)d比(4.5±0.4)d]及住院费用[(12 892±1 120)元比(14 273±1 328)元]均低，差异均有统计学意义(P均<0.05)。腹腔镜手术组的组间比较结果显示：Ⅲ组较Ⅰ、Ⅱ组的手术时间明显缩短[(55.8±10.2)min比(72.7±11.2)min；(55.8±10.2)min比(65.5±9.2)min]，出血量也明显减少[(15.1±5.1)mL比(25.3±5.2)mL；(15.1±5.1)mL比(21.6±4.3)mL]，差异均有统计学意义(P均<0.05)，表明通过学习曲线后相关指标能明显优化。术者的手术频数从0.85台/月(Ⅰ组)，逐步增加到2.5台/月(Ⅲ组)。

腹腔镜下胃十二指肠穿孔修补术能有效降低患者术后并发症发生率，有创伤小、安全可靠、术后恢复快等优点，值得临床推广。

To evaluate the surgical outcomes in different stages of laparoscopic gastroduodenal ulcer perforation and to investigate the learning curve.

Forty-four cases [25 males and 19 females, aged from 28 to 78 years, average age (44.2±8.8)years] of perforated gastroduodenal ulcer(performed by X. J. between October 2015 and December 2017)in the Department of General Surgery were reviewed. All patients were divided into the laparoscopic group(n=33)and the laparotomy group (n=11, IV), in which the laparoscopic group were divided equally into 3 subgroups: group Ⅰ(October 2015September 2016), group Ⅱ (October 2016-May 2017), and group Ⅲ (June 2015-December 2017))according the time sequence of the operations. The relevant indicators were compared, the surgical effect at different stages was analyzed and the learning curve judged.

The indexes of operative time [(55.8±10.2)min vs.(72.3±9.4)min], intraoperative bleeding [(15.1±5.1)mL vs.(50.7±8.6)mL], antibiotics consumption [(5.6±0.3)d vs.(8.2±0.4)d], leaving bed time [(31.9±1.4)h vs(53.8±3.7)h], postoperative hospital stay [(6.5±0.4)d vs.(9.3±0.8)d], gastrointestinal movement recovery time [(3.5±0.4)d vs(4.5±0.4)d] and cost of hospitalization[(12 892±1 120)yuan vs.(14 273±1 328) yuan] were lower in laparoscopy group III than those in laparotomy group(P <0 .05). The indexes of operative time [(55.8±10.2)min vs.(72.7±11.2)min, (55.8±10.2)min vs.(65.5±9.2)min], intraoperative bleeding [(15.1±5.1)mL vs.(25.3±5.2)mL and(15.1±5.1)mL vs.(21.6±4.3)mL] were lower in laparoscopy group III than those in laparotomy group I and Ⅱ(P < 0.05); the correlation index was optimized obviously after learning curve. The operative frequency of groups Ⅰ-Ⅲ increased from 0.85/month to 2.5/month. The learning curve of laparoscopic gastroduodenal ulcer perforation for surgeon who was experienced in laparoscopic cholecystectomy was approximately 22 cases.

Laparoscopic gastroduodenal ulcer perforation can reduce the postoperative complications effectively, and has the characteristics of minimally invasive surgery, safe and reliable operation, rapid postoperative recovery, and so on, which is worthy of clinical popularization and application.