摘要
目的探讨腹腔镜在小肠梗阻中的临床应用价值。方法回顾性分析接受腹腔镜治疗的小肠梗阻患者32例,男11例,女21例,年龄19～91岁,平均60.3岁。其中22例有腹部手术史。采用腹腔镜探查梗阻原因,解除梗阻病灶,恢复肠管通畅。结果本组患者术后粘连22例,小肠间质瘤3例,粪石梗阻2例,急性阑尾炎2例,肠套叠1例,假性肠梗阻2例,腹腔镜诊断准确率为93.8%(30/32)。全腹腔镜手术治疗15例,病变局部区域小切口辅助腔镜治疗8例,中转开腹9例。平均手术时间40 min(25～160 min),无腔镜手术相关死亡。平均住院天数4.2 d。随访12～36个月,无小肠梗阻复发。结论对于梗阻原因不明,保守治疗无效的小肠梗阻来说,腹腔镜是一种安全有效的诊断和治疗手段,但血流动力学不稳、腹胀明显,合并内科严重心脑肺部疾病的患者视为腔镜手术禁忌。对手术中显露困难,粘连广泛,脏器损伤的患者仍需中转开腹。
Objective To explore the clinical value of laparoscopy for small bowel obstruction. Methods The clinical data of 32 patients who underwent laparoscopy for small bowel obstruction were reviewed retrospectively, including 11 male and 21 female, averaged 60. 3 years（ 19-91 years）. Among them, 22 cases had abdominal operation before. Laparoscopie technology was used to removed the adhesion and unobstructed the intestine. Results There were 22 cases of adhesion, 3 cases of small intestinal stromal tumor, 2 cases of bezoar, 2 ca- ses of acute appendicitis, 1 case of intussusception and 2 cases of pseudo-obstruction postoperatively. The diagnostic accuracy of laparoscopy was 93.8%. Fifteen cases were treated by laparoseopy alone,8 cases were treated by laparoscopy combined with small target incision for segmental resection, 9 cases were converted to laparotomy. The average operation time was 40 minutes （25 - 160 minutes）. No death record was reported. The mean hospital stay was 4.2 days. During the follow-up of 12-36 mouths, no case of recurrent obstruction was reported. Conclusion Laparoscopy is a useful minimally invasive technique for acute small bowel obstruction. The patients with hemodynamic instability, peritonitis and heart and lung diseases should not undergo laparoscopy and those with adhesion densitya, exposure difficult and organs injury still require open surgery.
出处
《局解手术学杂志》
2012年第2期164-165,168,共3页
Journal of Regional Anatomy and Operative Surgery
关键词
小肠梗阻
腹腔镜
诊断
治疗
small bowel obstruction
laparoscopy
diagnosis
treatment
