复杂急腹症的腹腔镜手术经验  

Laparoscopic laparotomy for acute complicated abdomen

作　　者：高文涛[1] 吴峻立[1] 蒋奎荣[1] 郭峰[1] 陈建敏[1] 卫积书[1] 陆子鹏[1] 钱祝银[1] 戴存才[1] 苗毅[1] 

机构地区：[1]南京医科大学第一附属医院胰腺外科中心,210029

出　　处：《中华普通外科杂志》2014年第12期930-933,共4页Chinese Journal of General Surgery

摘　　要：目的 分析在腹腔镜下完成复杂急腹症手术的疗效.方法 回顾性分析在2011年4月至2014年3月之间共实施199例急腹症急诊手术.结果 实施开放手术51例,腹腔镜手术148例.腹腔镜下完成确定性手术145例,中转开腹3例.按病因分类,开放、腹腔镜手术各包括：急性胆囊炎0、31例,急性胆管炎1、17例,嵌顿膈疝0、3例,腹壁疝7、4例,阑尾炎5、67例,消化道穿孔7、11例,小肠梗阻8、7例,结肠梗阻10、3例;按手术级别分类,开放、腹腔镜的Ⅳ、Ⅲ、Ⅱ、Ⅰ级手术分别为3、0例,22、55例,21、26例,5、67例.腹腔镜Ⅰ～Ⅲ级手术均多于开放手术,包括全腹腔镜下右半结肠、左半结肠切除、胆总管探查、膈疝修补、斜疝修补等.依时间划分,腹腔镜总手术比例、Ⅲ级手术比例均在2013年度显著增加,分别达到82％和84％.另外,开放、腹腔镜手术因并发症2次手术率、死亡率相比差异无统计学意义.开放手术平均术后住院时间、住院费用均高于腹腔镜手术.结论 腹腔镜能完成大多数包括Ⅲ级急腹症手术,中转开腹率低,不增加并发症死亡率,患者住院时间、费用下降.急腹症中对胆道疾病、膈疝、消化道穿孔、阑尾炎应优先选择腹腔镜;对结肠梗阻、小肠梗阻、嵌顿疝腹腔镜手术可行,而对实质脏器外伤、消化道出血、肠系膜动脉栓塞则应优先选择开放手术.Objective To evaluate laparoscopic surgery m acute compncated abdomen.Method Retrospective analysis was done in 199 emergency surgeries for acute complicated abdomen from April 1,2011 to March 31,2014.Results Ratio of open and laparoscopic surgeries was 0/31 in acute cholecystitis,1/17 in acute cholangitis,5/67 in appendicitis,7/7 in cases of incarcerated hernia,7/11 in gastrointestinal perforation,8/7 in small bowel obstruction,and 10/3 in colon obstruction.Operations were graded according to complexity and risks,the distribution for open or laparoscopic surgery was 3/0,22/55,21/26 and 5/67 for individual grade respectively.Complication-caused reoperation rate and mortality was not statistically different between laparoscopic and open surgery.Laparoscopic surgery has shorter postoperative hospital stay and less total expense.Conclusions Laparoscopy is feasible to complete most of abdominal emergency surgery including complicated high grade surgery,with comparable morbidity and mortality and less hospital stay and expense than open surgery.

关 键 词：急腹症 腹腔镜 

分 类 号：R656.1[医药卫生—急诊医学]