经腹腔镜处理胃肠道开腹手术后并发腹腔出血  

Clinical application of laparoscopic reoperation on intra-abdominal hemorrhage after open gastrointestinal operation

作　　者：郑直[1] 李明杰[1] 李凯[1] 何涛[1] 郑小林[1] 王勇[1] 屈碧辉[1] 段鑫[1] 

机构地区：[1]武汉市中心医院普通外科,430014

出　　处：《腹部外科》2012年第1期24-25,共2页Journal of Abdominal Surgery

摘　　要：目的探讨传统胃肠道开腹手术后近期并发腹腔出血时腹腔镜再手术的临床应用价值。方法2008年2月至2011年3月行胃肠道开腹手术后近期出现腹腔大出血需再手术者9例，对其采用腹腔镜探查处理。结果9例中，术野出血6例、脾破裂出血1例、空肠造瘘处出血1例、腹腔引流管戳孔处出血1例。均予以急诊腹腔镜探查术，根据术中发现，完全腹腔镜下实施缝扎或可吸收夹夹闭止血术6例、脾切除1例、造瘘口止血修补1例、腹腔引流管戳孔处扩创止血1例。再手术时间40～170min，无中转。结论开腹胃肠道术后出现腹腔大出血等严重并发症需再手术时，部分病例可选择腹腔镜探查及处理，是一种迅速有效、损伤较小的方法，有一定的应用价值。Objective To explore the clinically applied value of laparoscopic reoperation on early intra-abdominal hemorrhage after open gastrointestinal operation. Methods From Feb. 2008 to Mar. 2011,9 cases subject to treatment of reoperation due to early intra-abdominal hemorrhage after open gastrointestinal operation were analyzed. The manner and value of laparoscopic reoperation were evalu- ated. Results Among 9 cases, there were 6 cases of errhysis or hemorrhage on wound surface, 1 case of splenic rupture, l case of hemorrhage on stoma of jejunum and I case of bleeding in the hole placed peritoneal cavity drainage tube. According to the examination in the laparoscopic laparotomy, these pa- tients received laparoscopic reoperation., hemostasia by transfixion or absorbable clips （6 cases）, laparo- scopic splenectomy （1 case）, repair of stoma of jejunum （1 case）, and the hole wound reconstruction （1 case）. Procedures were all successful in 9 patients, there was no conversion,and average operating time was 40-170 min. Conclusion Once serious complications of intra-abdominal hemorrhage after open gastrointestinal operation occur, a part of patients can be subjected to laparoscopic laparotomy, which is effective and minimally invasive.

关 键 词：再手术 腹腔镜 手术后并发症 胃肠道 

分 类 号：R473.6[医药卫生—护理学]