腹腔镜在腹内疝诊治中的应用  

Use of laparoscopy in diagnosis and treatment of internal hernia

作　　者：乔纯忠[1] 程国昌[1] 曹赣[1] 葛永祥[1] 王勇[1] 王宏刚[1] 刘庆宏[1] 

机构地区：[1]泰州市人民医院普外科,江苏泰州225300

出　　处：《外科理论与实践》2016年第6期525-528,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨腹腔镜在腹内疝的诊治中的应用。方法 :回顾性分析22例2008年6月至2015年6月在我院诊治412例急性小肠梗阻病人,其中22例腹内疝。12例采用腹腔镜探查为腔镜组,10例开腹手术探查为开腹组。统计两组病人的手术时间、术中出血量、术后肠功能恢复时间、术后住院时间、术后并发症发生率。结果:腔镜组有1例横结肠大网膜附着处裂孔疝和1例子宫阔韧带缺损疝。12例腔镜组病人中,3例嵌顿小肠肠管坏死,予中转小切口开腹解除内疝并切除坏死肠管后一期吻合,其余9例均在全腔镜下完成梗阻松解及内疝复位或修补。手术出血量(34.1±26.8)m L,手术时间(50.8±22.7)min,术后肠功能恢复时间(23.3±11.8)h,术后住院时间(4.2±1.9)d。开腹组中有1例先天性盲肠旁疝和1例十二指肠旁疝。10例病人中有5例行坏死小肠切除。腔镜组病人手术时间、术后肠功能恢复时间、术后住院时间较开腹组明显缩短,术中出血量少于对照组,术后并发症发生率低于对照组,其差异有统计学意义(P<0.05)。结论:腹内疝术前确诊困难,对于腹痛剧烈及肠梗阻经保守治疗效果不佳的病人需考虑腹内疝可能,腹腔镜对其进行诊治安全、简单且疗效确切。Objective To evaluate laparoscopy in the diagnosis and treatment of internal hernia. Methods A retrospective analysis was done with 412 cases of acute small intestine obstruction, in which 22 cases were diagnosed during operation as internal hernia in the period from June 2008 to June 2015 in our hospital. Twelve cases received laparoscopy as laparoscopic group（LG） and 10 cases received laparotomy as open surgery group（OG）. Clinical data of the patients in 2groups including operative time, blood loss, bowel function recovery, hospital stay after surgery, and complication rate were analyzed. Results There were 1 case with transverse mesocolic and omentum majus hernia and 1 case with the defect of broad ligament of uterus in LG. Three patients were found small intestinal necrosis and converted open surgery was made for management of hernia and resection of necrotic bowel. The other 9 patients were treated successfully with laparoscopic procedure. The blood loss was（34.1±26.8） m L with operation time（50.8±22.7） min, bowel function recovery time（23.3±11.8） hours and postoperative hospital stay（4.2±1.9） days. In OG 1 case was found with congenital paracecum hernia and 1 case with paraduodenal hernia. Five in all 10 cases had resection of necrotic intestine. The operation time,blood loss, bowel function recovery time and postoperative hospital stay were less in LG than those in OG statistically（P〈0.05）. Also the postoperative complication rate was less in LG. Conclusions Internal hernia is difficult to be diagnosed preoperatively. For the intestinal obstruction patients with severe abdominal pain and ineffective non-operative treatment,differentiated diagnosis of internal hernia should be done and laparoscopy would be safe, simple and effective procedure in the diagnosis and treatment.

关 键 词：腹内疝 腹腔镜 肠梗阻 

分 类 号：R656.24[医药卫生—外科学]