腹腔镜在腹部创伤早期诊治中的作用  

Laparoscopy in early diagnosis and treatment of abdominal trauma

作　　者：黄显凯[1] 张连阳[1] 王涛[1] 朱渝军[1] 

机构地区：[1]第三军医大学大坪医院全军战创伤中心,重庆400042

出　　处：《中国急救复苏与灾害医学杂志》2010年第1期25-27,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨腹部创伤应用腹腔镜诊断及治疗的方法。方法对45例腹部创伤患者进行腹腔镜探查，其中闭合性腹部损伤36例，开放性腹部损伤9例。入院时18例有明显的腹膜刺激征，14例超声示腹腔积液，18例腹穿阳性，8例腹透见膈下游离气体，有失血性休克表现5例。结果发现腹部多脏器伤17例，单脏器伤28例。肝破裂12例，脾破裂9例，小肠破裂15例，结肠破裂4例，肠系膜血管破裂出血6例，大网膜血管破裂出血3例，腹膜后血肿9例，阴性探查5例。9例肝破裂缝合修补加填大网膜止血，3例肝破裂因损伤严重中转开腹手术。3例边缘型脾破裂行缝合修补术，6例脾破裂损伤接近脾门伴活动性出血而行睥切除。10例小肠破裂5例直接缝合修补，5例较严重的小肠广泛损伤加腹壁小切口将损伤肠管提出切口外行部分肠切除吻合。4例结肠破裂均中转开腹手术，其中1例升结肠破裂行破口修补，3例降结肠损伤行肠修补加肠外置术。6例肠系膜血管破裂出血及3例大网膜血管破裂均行缝扎止血。9例腹膜后血肿未作处理。术后无并发症，所有病例均治愈出院。结论腹腔镜用于诊治腹部创伤安全、准确、并发症少，对早期难以确诊的腹部创伤具有优越性。Objective To explore the role of laparoseopy in the early diagnostic and treatment of abdominal trauma. Methods Forty-five patients with abdominal trauma, 36 with closed injuries and 9 with open injuries, 18 with obvious signs of peritoneal irritation and 14 with aseites by uhrasonography, 18 with positive peritoneocentesis, 8 with subdiaphragmatie free air by X-ray, and 5 with hemorrhagic shock, underwent laparoseopy. Results Seventeen cases of muhlple organ injuries and 28 cases of single organ injuries were confirmed, including 12 eases of hepatic rupture, 9 cases of splenic rupture, 15 cases of small intestinal rupture, 4 cases of colon rupture, 6 cases of mesentery vessel rupture, 3 cases of greater omentum vessel rupture, and 9 cases of retroperiloneal hemorrhage. Five cases showed negative exploration. Nine cases with hepatic rupture underwent suture, repair and packing with greater omentum, and the other 3 cases were converted to laparotomy because of the severe condition. Three cases of peripheral type of splenic rupture underwent suture and repair, and the other 6 underwent splenectomy because of the injury adjacent to hilum of spleen complicated by active bleeding. Of the 10 cases with small intestinal rupture, 5 directly underwent suture and repair, and the other 5 with severe injury underwent partial excision and anastomosis of the intestine taken out of the body surface through small incision on abdominal wall. Four cases of colon rupture were alll conveted to laparotomy, of which 1 case with ascending colon rupture underwent repair and 3 cases with descending colon rupture underwent repair and intestinal exteriorization. Six cases of mesentery vessel rupture and 3 cases with greater omentum vessel rupture all underwent transfixion to stop the bleeding. Nine cases of retroperitoneal hematoma did not undergo any treatment. All patients were cured, and no complication was found. Conclusion Safe,accurate and with less complication, laparoscopy is helpful in early diagnosis and treatment of abdominal tr

关 键 词：腹部创伤 腹腔镜 手术 诊断 

分 类 号：R641[医药卫生—外科学]