Department of General Surgery, Chengdu Second People’s Hospital Affiliated to Sichuan University, Chengdu 610017, P. R. China_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIAO Gang , LI Dandan , SHEN Jian , YANG Peng , HUANG Shuoyang , HE Xuelai , ZHENG Minjiang , ZUO ZhongLin ,  HE Shan

四川大学附属成都市第二人民医院普外科（成都 610017）;

Corresponding author：

HE Shan, Email: 2642159166@qq.com

Keywords：

transumbilical three-port laparoscopic surgery; transumbilical single-incision laparoscopic surgery; acute peptic ulcer perforation

DOI：

10.7507/1007-9424.202503128

Video：

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Objective To compare clinical efficacy between transumbilical three-port laparoscopic surgery (TU-TPLS) and transumbilical single-incision laparoscopic surgery (TU-SILS) in repair of acute peptic ulcer perforation. Methods The patients with acute peptic ulcer perforation who underwent TU-TPLS or TU-SILS in Chengdu Second People’s Hospital Affiliated to Sichuan University from January 2022 to December 2024 were retrospectively collected, and then were divided into the TU-TPLS group and TU-SILS group. The operation time, postoperative 24 h incision pain score (visual analogue scale) , postoperative hospital stay, total hospitalization cost, incision scar score (Vancouver scar scale), comprehensive satisfaction, and postoperative complications were compared between the two groups. The statistical significance was defined as α=0.05. Results A total of 105 patients met the inclusion criteria were enrolled, comprising 50 patients in the TU-TPLS group and 55 patients in the TU-SILS. There were no statistically significant differences in baseline characteristics between the two groups, such as gender, age, body mass index, perforation site, perforation diameter, and Boey score (all P>0.05). Postoperatively, the TU-TPLS group demonstrated significantly lower visual analogue scale pain score at 24 h compared to the TU-SILS group [(2.34±0.63) score vs. (3.22±1.05) score, P<0.001] and significantly higher comprehensive satisfaction score [(7.60±0.86) score vs. (7.02±1.01) score, P=0.002]. However, no statistically significant differences were observed between the TU-TPLS group and TU-SILS group regarding operative time [(71.84±10.51) min vs. (69.78±7.98) min, P=0.257], postoperative hospital stay [(10.35±2.08) d vs. (9.96±1.75) d, P=0.310], or total hospitalization costs [(20 856.23±4 095.73) yuan vs. (19 988.83±2 933.43) yuan, P=0.212]. The incidence of umbilical wound infection was 1 case in the TU-TPLS group and 3 cases in the TU-SILS group (Fisher exact test, P=0.619). Postoperative residual intra-abdominal infection occurred in 2 cases in the TU-TPLS group and 1 case in the TU-SILS group (Fisher exact test, P=0.604). Incisional bleeding occurred in 0 cases in the TU-TPLS group and 1 case in the TU-SILS group (Fisher exact test, P>0.999). Furthermore, there was no statistically significant difference in the scar assessment score between the TU-TPLS group and TU-SILS group [(3.11±1.13) score vs. (2.92±0.70) score, P=0.301] at the 2-month postoperative follow-up. Conclusions Both TU-TPLS and TU-SILS have achieved good therapeutic effects in treatment of acute peptic ulcer perforation. However, TU-TPLS has more advantages over TU-SILS. TU-TPLS causes milder incision pain, leads to higher patient satisfaction, and does not require special equipment.

1.	沈剑涛, 王西刚, 凌新建, 等. 消化性溃疡穿孔病人术后死亡危险因素分析及列线图模型构建. 腹部外科, 2025, 38(2): 128-133.
2.	邱小琴. 奥美拉唑四联疗法辅助腹腔镜手术对消化性溃疡穿孔患者机体炎性反应及复发的影响. 临床合理用药, 2024, 17(7): 52-55.
3.	陈韬, 梁炜祺, 陈嘉文, 等. 单孔腹腔镜胃癌手术的发展历程与未来展望. 消化肿瘤杂志(电子版), 2023, 15(2): 114-119.
4.	吴卫东, 张一忠, 王廷峰, 等. 单孔腹腔镜腹股沟疝手术规范化操作中国专家共识(2023版). 中国实用外科杂志, 2023, 43(1): 34-47.
5.	Keller DS, Reif de Paula T, Ikner TP, et al. Perioperative outcomes for single-port robotic versus single-incision laparoscopic surgery: A comparative analysis in colorectal cancer surgery. Surg Endosc, 2024, 38(3): 1568-1575.
6.	Dapri G, El Mourad H, Himpens J, et al. Transumbilical single-access laparoscopic perforated gastric ulcer repair. Surg Innov, 2012, 19(2): 130-133.
7.	Lee J, Sung K, Lee D, et al. Single-port laparoscopic repair of a perforated duodenal ulcer: Intracorporeal “cross and twine” knotting. Surg Endosc, 2011, 25(1): 229-233.
8.	Chae JK, Kim JH, Kim EJ, et al. Values of a patient and observer scar assessment scale to evaluate the facial skin graft scar. Ann Dermatol, 2016, 28(5): 615-623.
9.	刘海兵, 唐丹, 曹海燕, 等. 温哥华瘢痕量表的信度研究. 中国康复医学杂志, 2006, 21(3): 240-242.
10.	Yuda Handaya A, Andrew J, Hanif AS, et al. Omental plug using double horizontal mattress suture for gastric perforation on elderly patients with boey score 3: A case series. Ann Med Surg (Lond), 2021, 68: 102647. doi: 10.1016/j.amsu.2021.102647.
11.	Nguyen TH, Dang TN, Schnelldorfer T. Single-port laparoscopic repair of perforated duodenal ulcers. World J Surg, 2020, 44(5): 1425-1430.
12.	乔明静, 杨立, 徐臻, 等. 妇科经脐单孔腹腔镜手术并发症的预防及处理河南专家共识. 河南医学研究, 2024, 33(23): 4225-4229.
13.	Murad MF, Khan R, Tariq M, et al. Laparoscopy: A better approach for perforated duodenal ulcer. Cureus, 2020, 12(10): e10953. doi: 10.7759/cureus.10953.
14.	郑莹, 熊光武, 刘娟, 等. 经脐单孔腹腔镜手术脐部切口管理专家共识(2022年版). 实用妇产科杂志, 2022, 38(3): 192-197.
15.	王鹏, 郭青松, 凌长春. 单孔腹腔镜手术后脐窝创面的简单缝合术. 腹腔镜外科杂志, 2016, 21(12): 958-960.
16.	Lee E, Lim D, Kang SH, et al. Single-port intragastric wedge resection using the tunnel method: A novel surgical approach for treating endophytic gastric subepithelial tumors. Surg Endosc, 2024, 38(2): 1106-1112.
17.	Lu Z, Chen Y, Xiao C, et al. Transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy for apical prolapse after total/subtotal hysterectomy: Chinese surgeons’ initial experience. BMC Surg, 2024, 24(1): 25. doi: 10.1186/s12893-023-02304-z.
18.	刘欢欢, 田雨, 吴硕东, 等. 经脐单孔腹腔镜阑尾切除术治疗急性阑尾炎的应用价值及经验总结. 中国普外基础与临床杂志, 2018, 25(11): 1372-1374.
19.	肖刚, 于宏. 单孔腹腔镜手术中肝脏牵拉方法的应用进展. 中国微创外科杂志, 2019, 19(01): 72-76.
20.	刘勇, 李大伟, 王永高, 等. 双孔法与三孔法腹腔镜十二指肠球部前壁溃疡穿孔修补术的临床比较. 中国普通外科杂志, 2015, 24(12): 1771-1774.
21.	Pang YF, Shu L, Xia CW. Retrospective comparative study of different surgical methods for gastric ulcer perforation: Efficacy and postoperative complications. World J Gastrointest Surg, 2025, 17(2): 101896.
22.	Kim TH, Park JH, Jeong SH, et al. Feasibility of a novel laparoscopic technique with unidirectional knotless barbed sutures for the primary closure of duodenal ulcer perforation. Surg Endosc, 2018, 32(8): 3667-3674.
23.	商莹, 王宇男, 查恩华. 两种不同脐部入路方式在单孔腹腔镜阑尾切除术中的对比研究. 黑龙江医学, 2024, 48(20): 2470-2472.

1. 沈剑涛, 王西刚, 凌新建, 等. 消化性溃疡穿孔病人术后死亡危险因素分析及列线图模型构建. 腹部外科, 2025, 38(2): 128-133.
2. 邱小琴. 奥美拉唑四联疗法辅助腹腔镜手术对消化性溃疡穿孔患者机体炎性反应及复发的影响. 临床合理用药, 2024, 17(7): 52-55.
3. 陈韬, 梁炜祺, 陈嘉文, 等. 单孔腹腔镜胃癌手术的发展历程与未来展望. 消化肿瘤杂志(电子版), 2023, 15(2): 114-119.
4. 吴卫东, 张一忠, 王廷峰, 等. 单孔腹腔镜腹股沟疝手术规范化操作中国专家共识(2023版). 中国实用外科杂志, 2023, 43(1): 34-47.
5. Keller DS, Reif de Paula T, Ikner TP, et al. Perioperative outcomes for single-port robotic versus single-incision laparoscopic surgery: A comparative analysis in colorectal cancer surgery. Surg Endosc, 2024, 38(3): 1568-1575.
6. Dapri G, El Mourad H, Himpens J, et al. Transumbilical single-access laparoscopic perforated gastric ulcer repair. Surg Innov, 2012, 19(2): 130-133.
7. Lee J, Sung K, Lee D, et al. Single-port laparoscopic repair of a perforated duodenal ulcer: Intracorporeal “cross and twine” knotting. Surg Endosc, 2011, 25(1): 229-233.
8. Chae JK, Kim JH, Kim EJ, et al. Values of a patient and observer scar assessment scale to evaluate the facial skin graft scar. Ann Dermatol, 2016, 28(5): 615-623.
9. 刘海兵, 唐丹, 曹海燕, 等. 温哥华瘢痕量表的信度研究. 中国康复医学杂志, 2006, 21(3): 240-242.
10. Yuda Handaya A, Andrew J, Hanif AS, et al. Omental plug using double horizontal mattress suture for gastric perforation on elderly patients with boey score 3: A case series. Ann Med Surg (Lond), 2021, 68: 102647. doi: 10.1016/j.amsu.2021.102647.
11. Nguyen TH, Dang TN, Schnelldorfer T. Single-port laparoscopic repair of perforated duodenal ulcers. World J Surg, 2020, 44(5): 1425-1430.
12. 乔明静, 杨立, 徐臻, 等. 妇科经脐单孔腹腔镜手术并发症的预防及处理河南专家共识. 河南医学研究, 2024, 33(23): 4225-4229.
13. Murad MF, Khan R, Tariq M, et al. Laparoscopy: A better approach for perforated duodenal ulcer. Cureus, 2020, 12(10): e10953. doi: 10.7759/cureus.10953.
14. 郑莹, 熊光武, 刘娟, 等. 经脐单孔腹腔镜手术脐部切口管理专家共识(2022年版). 实用妇产科杂志, 2022, 38(3): 192-197.
15. 王鹏, 郭青松, 凌长春. 单孔腹腔镜手术后脐窝创面的简单缝合术. 腹腔镜外科杂志, 2016, 21(12): 958-960.
16. Lee E, Lim D, Kang SH, et al. Single-port intragastric wedge resection using the tunnel method: A novel surgical approach for treating endophytic gastric subepithelial tumors. Surg Endosc, 2024, 38(2): 1106-1112.
17. Lu Z, Chen Y, Xiao C, et al. Transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy for apical prolapse after total/subtotal hysterectomy: Chinese surgeons’ initial experience. BMC Surg, 2024, 24(1): 25. doi: 10.1186/s12893-023-02304-z.
18. 刘欢欢, 田雨, 吴硕东, 等. 经脐单孔腹腔镜阑尾切除术治疗急性阑尾炎的应用价值及经验总结. 中国普外基础与临床杂志, 2018, 25(11): 1372-1374.
19. 肖刚, 于宏. 单孔腹腔镜手术中肝脏牵拉方法的应用进展. 中国微创外科杂志, 2019, 19(01): 72-76.
20. 刘勇, 李大伟, 王永高, 等. 双孔法与三孔法腹腔镜十二指肠球部前壁溃疡穿孔修补术的临床比较. 中国普通外科杂志, 2015, 24(12): 1771-1774.
21. Pang YF, Shu L, Xia CW. Retrospective comparative study of different surgical methods for gastric ulcer perforation: Efficacy and postoperative complications. World J Gastrointest Surg, 2025, 17(2): 101896.
22. Kim TH, Park JH, Jeong SH, et al. Feasibility of a novel laparoscopic technique with unidirectional knotless barbed sutures for the primary closure of duodenal ulcer perforation. Surg Endosc, 2018, 32(8): 3667-3674.
23. 商莹, 王宇男, 查恩华. 两种不同脐部入路方式在单孔腹腔镜阑尾切除术中的对比研究. 黑龙江医学, 2024, 48(20): 2470-2472.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesDepartment of General Surgery, Chengdu Second People’s Hospital Affiliated to Sichuan University, Chengdu 610017, P. R. China

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