目的 探讨3D腹腔镜胃穿孔修补术治疗胃溃疡合并胃穿孔患者临床应用价值。方法 选取2022年1月—2025年1月十堰市茅箭区人民医院收治的80例胃溃疡合并胃穿孔患者,采用随机数字表法分为观察组和对照组,每组各40例。接受传统开腹胃穿孔修补术者纳入对照组,接受3D腹腔镜胃穿孔修补术者纳入观察组,对两组术后胃肠功能恢复时间（肠鸣音恢复时间、首次排气时间、首次排便时间）、术后3 d肠黏膜屏障功能指标（二胺氧化酶、D-乳酸、内毒素）、临床预后指标（手术时间、术中出血量、住院时间、并发症发生率）等进行比较。结果 观察组术后胃肠功能恢复时间均短于对照组（P<0.05）;术后3 d,观察组血清二胺氧化酶、D-乳酸、内毒素水平均低于对照组（P<0.05）;观察组与对照组比较,手术耗时延长,但术中失血量更少、术后住院时间更短,且并发症发生率更低（P<0.05）。结论 采用3D腹腔镜技术行穿孔修补,可显著促进胃溃疡合并胃穿孔患者胃肠动力恢复,维护肠黏膜屏障功能,降低术后不良事件风险,从而优化整体预后,具有良好推广应用前景。

Objective To explore the value of 3D laparoscopic gastric perforation repair surgery for patients with gastric ulcer complicated with gastric perforation. Methods A total of 80 patients with gastric ulcer combined with gastric perforation were selected from January 2022 to January 2025 at Maojian District People's Hospital, Shiyan City, and randomly divided into two groups, each containing 40 cases, following the random number table method. Those who received traditional open gastric perforation repair surgery were included in the control group. Those who received 3D laparoscopic gastric perforation repair surgery were included in the observation group. The following indicators were compared between the two groups： postoperative gastrointestinal function recovery time （time to return of bowel sounds, time to first flatus, and time to first defecation）, postoperative day 3 intestinal mucosal barrier function indicators （diamine oxidase, D-lactic acid, and endotoxin）, and clinical prognosis indicators （surgery time, intraoperative blood loss, length of hospital stay, and incidence of complications）. Results The recovery time of gastrointestinal function was shorter in the observation group than in the control group （P<0.05）. On postoperative day 3, the levels of serum diamine oxidase, D-lactic acid, and endotoxin in the observation group were all lower than those in the control group （P<0.05）. Prolonged operation time, but less intraoperative blood loss, shorter postoperative hospital stay, and lower complication rates were observed in the observation group than in the control group （P<0.05）. Conclusion Using 3D laparoscopic technology for perforation repair can significantly promote the recovery of gastrointestinal motility in patients with gastric ulcer complicated by gastric perforation, maintain the function of the intestinal mucosal barrier, reduce the risk of postoperative adverse events, thereby optimizing overall prognosis, and showing good prospects for widespread application.