To evaluate the clinical application value of laparoscopic repair for perforated anterior duodenal bulb ulcers. Seventy-five young cases of duodenal ulcer perforation admitted to our hospital from January 2003 to December 2006 were randomly grouped; 40 cases received laparoscopic repair treatment and 35 cases received conventional open repair. There were significant differences (p<0.05) in the recovery of gastrointestinal function, use of postoperative analgesics, and mean hospital stay between the two groups, and there were no postoperative complications such as bleeding, intermediate open abdomen, or reperforation in either group. Laparoscopic repair of anterior wall ulcer perforation of the duodenal bulb in young people is clinically safe and feasible, and should be promoted as the preferred method in clinical practice. Perforated duodenal bulb ulcer is a common acute abdominal disease in abdominal surgery, especially in young people. The research and application of drugs have made the treatment of duodenal ulcer no longer difficult, but because young people cannot take drugs regularly and live an unregulated life, although the clinical cure rate of duodenal ulcer has gradually increased, the incidence of perforated duodenal ulcer in young people has not decreased significantly. The traditional treatment of duodenal ulcer perforation received open repair or major gastrectomy, but due to the improvement of ulcer cure rate in recent years, young people with duodenal ulcer perforation mostly receive repair. The purpose of this paper is to study the application value of laparoscopic repair for the treatment of anterior wall ulcer perforation of the duodenal bulb in young people. 1. Clinical data and methods 1.1 Clinical data Seventy-five cases of anterior wall ulcer perforation of the bulb of duodenum in young people admitted from January 2003 to December 2006 were randomly grouped. 40 cases received laparoscopic repair treatment and 35 cases received traditional open repair. The preoperative surgical indications were the same (refer to the volume of general surgery edited by Huang Zhiqiang), and the postoperative ulcer medication regimen was the same, with intravenous Loxac during fasting, oral acid-control medication after eating, and oral H. pylori eradication medication in H. pylori-positive cases. 40 cases received laparoscopic repair treatment group: age 15-34 years, median Age 26 years, onset time 3-23 hours, mean 10 hours, operation time 35-78 minutes, mean 43 minutes, compared with 35 cases receiving conventional open repair during the same period (see table for details). The postoperative anal venting time was based on the patient's first anal venting time. Postoperative bowel sound recovery time: every 8 hours, the abdomen was auscultated by a specially designated physician, and bowel sounds were found to be recovered at 3 or more times per minute, and the earliest time was recorded. 1.2 Laparoscopic repair of anterior wall ulcer perforation of the duodenal bulb Laparoscopic operation was performed in a supine, head-high, foot-low position under general anesthesia, CO2 pneumoperitoneum, intraoperative intra-abdominal pressure of 10 mmHg, 1 cm subumbilical incision, puncture placement of 10 mmTrocar, clear perforation of anterior wall ulcer of the duodenal bulb and continued operation, 5 mmTocar under the right midclavicular line rib margin and umbilical level midpoint, left side of the subxiphoid process The ulcer perforation was less than 0.5 cm (58/75) and the perforation was filled with gelatin sponge, and medical fibrin glue was sprayed on the surface of the perforation and the surrounding area of about 3 cm in diameter; the perforation larger than 0.5 cm (17/75) was repaired with laparoscopic stitches, and the large omentum was covered with figure-of-eight sutures. The peritoneal cavity was flushed with saline before the end of surgery, and the peritoneal fluid was thoroughly aspirated, and a negative suction bulb was placed to drain the cavity after surgery. 1.3 Follow-up 75 patients were followed up regularly after surgery, and gastroscopy was performed 3 months after surgery. 1.4 Statistical treatment The results were processed by SAS statistical software. p < 0.05 was considered to be statistically different. 2, Results Laparoscopic repair surgery was significantly different from traditional open repair surgery in terms of postoperative analgesic use, recovery of postoperative bowel sounds, postoperative anal venting, and hospitalization time (p<0.05), and there was no significant difference in mean age, disease duration, operative time, and hospitalization cost between the two groups of cases (p>0.05). All patients were followed up after surgery, and the average follow-up time was 18 months (7-28 months). No recurrence of ulcers was seen on gastroscopy, and there were no postoperative complications such as reperforation, intestinal adhesions, or intestinal obstruction. 3. Discussion 3.1 Basis of laparoscopic repair of perforated duodenal ulcer in young people Since the first report of laparoscopic repair of perforated duodenal ulcer in 1990, several studies have shown the superiority of this procedure over traditional open surgery. The pathogenesis of duodenal ulcer and gastric ulcer is complex and has not been elucidated so far. Current studies suggest that it is caused by the imbalance between the corrosive effect of gastric acid and pepsin on the stomach and duodenum and the defense ability of the gastrointestinal mucosa, and Helicobacter pylori infection has been considered an important cause of peptic ulcer in recent years. Other environmental, psychiatric, individual neuroendocrine response and factors are related to the development of peptic ulcer. With the in-depth research on the mechanism of peptic ulcer, clinical breakthroughs have been made in the treatment of H. pylori by drugs that inhibit gastric acid secretion and eradicate H. pylori, and the introduction of proton pump inhibitors has made the treatment of ulcer disease no longer a problem, and the eradication of H. pylori has reduced the incidence and recurrence of ulcer. The incidence of peptic ulcer in Beijing has been reported to be decreasing, so that drug cure for peptic ulcer disease will become possible. The current study of duodenal bulb ulcer believes that it will not become malignant, and there are many complications after major gastrectomy. Although Bi’s type I has less changes on the digestive tract, the recurrence rate is still high after surgery, and Bi’s type II has a great impact on the digestive tract, and there are more long-term complications after major gastrectomy, including residual gastric cancer. Studies have confirmed that duodenal ulcer is not only a local disease and surgical treatment is not a very ideal treatment option, with its own risks and frequent postoperative complications, still to ulcer recurrence [8]. Therefore, the treatment of perforated duodenal ulcers in young people prefers simple perforation repair and subsequent pharmacological treatment, and the cure of duodenal ulcers can completely rely on pharmacological treatment, and surgical destructive surgery is no longer the first choice. Since laparoscopic cholecystectomy was introduced into the clinic in 1989 and the first laparoscopic cholecystectomy was carried out in China in 1991, it is now laparoscopic cholecystectomy has become a mature surgical technique and laparoscopic biliary exploration and lithotripsy has become an effective and safe treatment tool [9]. In recent years, laparoscopic technology has advanced rapidly, and laparoscopic surgery for gastric cancer, pancreatic head cancer, and common bile duct stones can be completed, so laparoscopic repair for perforated anterior duodenal ulcers in young people is completely feasible, and laparoscopic repair for perforated duodenal ulcers in young people does not have a higher complication rate, which is confirmed by our data and other studies. 3.2 Experience of laparoscopic repair of perforated duodenal ulcers in young people There is no uniform standard for the indications of laparoscopic repair of perforated ulcers, and based on the possibility of malignancy of gastric ulcers, the occurrence of various long-term complications such as residual gastric cancer after major gastrectomy, and the difficulty of dealing with perforated ulcers in areas other than the anterior wall of the duodenal bulb, this study selected young people under 35 years of age with perforated ulcers in the anterior wall of the duodenal bulb The present study selected young people under 35 years of age with anterior duodenal ulcer perforation. For the specific perforation operation, the laparoscopic operation for anterior duodenal wall ulcer perforation is relatively simple, with caulking, suturing, and combining with large omental coverage. The authors experienced that the gelatin sponge could fill the perforation well during the surgery for perforations below 0.5 cm and was not easily dislodged, supplemented with medical protein glue coating; the gelatin sponge could not fill the perforation well for perforations above 0.5 cm and was easily dislodged, so the perforations were patched and covered with large omentum, and both methods received good results for different ulcer perforations, with no postoperative complications such as reperforation, and the recent results were significantly better than those of The recent results were significantly better than those of conventional surgery. 3.3 Evaluation of laparoscopic repair for anterior wall ulcer perforation of the bulb of duodenum in young people Laparoscopic repair for anterior wall ulcer perforation of the bulb of duodenum in young people has significant advantages such as less surgical trauma, less pain, less abdominal cavity disturbance, no alteration of the digestive tract, and faster recovery of gastrointestinal function after surgery, and laparoscopic repair for anterior wall ulcer perforation of the bulb of duodenum in young people can achieve the purpose of minimally invasive surgery. The present study confirms this result. Therefore, the authors concluded that laparoscopic repair of anterior wall ulcer perforation of the bulb of duodenum in young people is a safe and effective procedure that can achieve minimally invasive results and should be promoted as the preferred method in clinical practice. However, the small sample size and short follow-up time of this group of cases are yet to be confirmed by a large number of experimental and clinical studies.