机械性小肠梗阻的腹腔镜手术时机探讨  

作　　者：李慧诚[1] 刘习红[1] 李文煜[1] 梁晓雯[1] 

机构地区：[1]惠州市第一人民医院,广东516000

出　　处：《当代医学》2014年第5期10-11,共2页Contemporary Medicine

摘　　要：目的探讨机械性小肠梗阻的腹腔镜最佳手术时机。方法 2010年1月-2011年12月收治的130例机械性小肠梗阻的治疗及效果。其中,早期施行腹腔镜手术(ELS)患者58例,延期手术(PS)患者32例及保守治疗(ET)患者40例。比较不同治疗方案患者的疗效。结果 ELS组共计58例,无中转开腹病例,所有患者术后无严重并发症;PS组32例,治愈32例,16例出现不同程度的术后并发症;ET组40例,治疗后梗阻复发25例。ELS在手术时间、术中出血、术后恢复、住院费用及预后方面均优于PS组(P<0.05),ET组复发率最高(P<0.05),组间差异有统计学意义。结论在技术和设备完善的前提下,早期腹腔镜手术在机械性小肠梗阻的诊断、治疗及预后等方面优于传统的保守治疗及开腹手术。对于高度怀疑是机械性肠梗阻的,可尽快行腹腔镜探查明确诊断;机械性小肠梗阻一经诊断,建议行腹腔镜手术治疗。Objective To investigate the time window of laparoscopic surgery of mechanical small intestinal obstruction. Methods Clinical data of 130 cases with mechanical small intestinal obstruction of the hospital from January 2010 to December 2011 were analyzed, which including 58 cases treated with early laparoscopic surgery （group ELS）,32 cases of postpone surgery （group PS） and 40 cases of expectant treatment（group ET）. The investigation devises a treatment effectiveness evaluation among 3 groups. Results All 58 cases of group ELS were cured without converting to open laparotomy and serious postoperative complications. 16 of 32 cases of group PS appeared varying degrees of postoperative complications. 25 cases of 40 patients in group ET had obstruction relapsed. The study showed that group ELS are superior to group PS in operation time, intraoperative blood loss, postoperative recovery, hospitalization expense and prognosis（P〈0.05）, while group ET had a highest relapse rate（P〈0.05）. There are significant differences among 3 groups. Conclusion Early laparoscopic surgery has more advantages in early diagnosis, treatment effect and prognosis than postpone surgery and expectant treatment of mechanical small intestinal obstruction under the precondition of technical skills and better facilities. A laparoscopy exploration must be essential for that highly suspected to make a definitive diagnosis. Once the diagnosis is made, operation should be preformed and suggested.

关 键 词：机械性肠梗阻 腹腔镜 手术时机 早期诊断 预后 

分 类 号：R656.7[医药卫生—外科学]