免气腹腹腔镜在急腹症和腹部外伤诊治中的应用  

Gasless laparoscopy in diagnosis and treatment of acute abdomen and abdominal trauma

作　　者：姚健[1] 郑捍东[1] 赖俊谕[1] 

机构地区：[1]四川省泸州市人民医院,四川泸州646000

出　　处：《中国内镜杂志》2011年第5期507-509,513,共4页China Journal of Endoscopy

摘　　要：目的探讨应用免气腹腹腔镜诊断和治疗外科急腹症及腹部外伤的价值。方法回顾分析该院2007年11月～2010年4月因急腹症和腹部损伤需手术治疗且生命体征较平稳、无明显腹腔内大出血的患者78例,随机分为二氧化碳(CO2)气腹组(n=33)(对照组)和免气腹组(n=45)(实验组)。结果两组均在腹腔镜下完成手术,各有中转开腹1例,术中、术后生命体征均正常,术中常规安放血浆引流管,术后24～48h内拔除,5～7d痊愈出院。实验组和对照组比较手术时间、术中出血、住院时间差异均无显著性。45例免气腹组患者中有19例在不明病因的情况下由腹腔镜确诊,确诊率为100%,其中18例在免气腹腹腔镜下治疗,1例中转开腹;26例在明确病因下用免气腹腹腔镜治疗。结论免气腹腹腔镜技术在外科急腹症诊断及治疗中具有独特的优势,既可明确诊断,又能同时进行治疗,操作较气腹腹腔镜简单,无气腹腹腔镜并发症,损伤小,术后肠道功能恢复快,有良好的临床应用价值。[Objective] To investigate the value of gasless laparoscopy on the diagnosis and treatment of patients with acute abdomen and abdominal trauma. [Methods] A total of 78 patients with acute abdomen and abdominal trauma who underwent surgery were analyzed retrospectively from November 2007 to April 2010, who were with stable vital sign and no obviously bleeding in abdominal cavity. The patients were randomly divided into CO2 pneumoperitoneum group （n =33, control group）, gasless group （n =45, test group）. [Results] The two groups were under laparoscopy and 1 case in each group converted to open surgery. The patients all had normal vital during operation and post-operation, put drainage tube in 2~3 days routinely, stayed in hospital for 5-7 days. Time of the operations, hospitalization and volume of blood was not significant different among the two groups. Among the 45 patients, 19 cases with uncertain etiology were successfully diagnosed by laparoscopy,with a diagnosis rate of 100%;18 cases were operated under gasless laparoscopy and 1 case received open surgery. 26 cases with a certain pre-operative diagnosis were successfully cured by laparoscopy. [Conclusions] There exists a particular advantage in the diagnosis and treatment of acute abdomen by gasless laparoscopic surgery. It can be used to not only diagnose but also cure the disease at the same time, it is easier to control than laparoscopy, it has no laparoscopic complications, the wound is minimal, and function of intestinal tract recovers fast, so it is highly worthy of clinical application.

关 键 词：免气腹腹腔镜 急腹症 腹部损伤 

分 类 号：R656.1[医药卫生—急诊医学]