腹腔镜技术在腹部闭合伤中的应用价值  

Laparoscopy for diagnosis and treatment of blunt abdominal trauma

作　　者：史佩东 陈跃宇 郭润生 

机构地区：[1]上海市嘉定区中心医院普外科,201800

出　　处：《中华全科医学》2014年第6期864-865,967,共3页Chinese Journal of General Practice

基　　金：上海市重点专科资金资助(ZK2012A15);上海市嘉定区卫生局课题(KYXM 2009-12-3)

摘　　要：目的分析腹腔镜技术在腹部闭合性外伤中的诊断与治疗的临床价值。方法2008年1月—2013年10月，对100例腹部闭合伤患者使用腹腔镜探查，并根据腹腔镜探查结果决定是否行镜下治疗或中转开腹手术。结果100例患者98例经探查后均获明确诊断，2例探查阴性。中转开腹25例。平均手术时间91rain（29～201min），对于治疗性的患者的平均手术时间为121min（50～182min）。住院时间3～20d，平均8．9d。其中腹腔镜手术的患者住院时间为3～12d，平均6．5d，其中2例探查阴性的患者住院时间为3d。中转开腹的住院时间为8～22d，平均10．4d。75例闭合性外伤患者避免了开腹手术。其中包括5例胆囊破裂，6例脾脏包膜下小血肿，14例小肠破裂，5例大网膜破裂出血，9例肠系膜出血，3例结肠浆膜破裂，11例后腹膜血肿，均在腹腔镜下行手术治疗。有11例术后有并发症，均为中转开腹患者，其中肺部感染6例，切口感染4例，1例肠梗阻。所有患者均康复出院。结论腹腔镜诊治腹部闭合伤具有创伤小、安全可靠、诊断率高、能有效降低阴性剖腹探查率、住院时间缩短、并发症少等优点。对于临床诊断困难的腹部闭合性损伤可达到诊断与治疗的双重目的，对于腹腔镜下不能完成诊治的病例，也可给中转开腹指明方向。Objective To evaluate the clinical value of laparoscopy in the diagnosis and treatment of blunt abdominal trauma. Methods Lapamscopic exploration was performed in 100 cases of blunt abdominal trauma from January 2008 to October 2013. Laparoscopic or open operation methods were selected according to the result of exploration. Results 98 of 100 patients were confirmed by lapamseopic exploration,other 2 cases were negative. 25 cases were conversed to laparoto- my. The average operation time for the exploration was 91 minutes （29 -201 minutes） , while the average time for the ex- ploration and treatment was 121 minutes（50 - 182 minutes）. All patients were discharged from hospitals upon recovery. Conclusion The laparoscopy for the diagnosis and treatment of blunt abdominal trauma is with minimal invasion, high security, high diagnostic accuracy rate, low laparotomy rate, shorter hospital stay and less complications. The laparoscopy can be used both in the diagnosis and treatment of blunt abdominal trauma, and can also give direction to laparotomy.

关 键 词：腹部闭合伤 腹腔镜 

分 类 号：R656[医药卫生—外科学]