腹腔镜技术在顽固性粘连性肠梗阻治疗中的应用  

Application of laparoscopic technique in the treatment of refractory adhesive intestinal obstruction

作　　者：卢新泉 刁德昌[2] 熊文俊[2] 刘鹏飞 李洪明[2] 邹瞭南[2] 万进[2] 

机构地区：[1]广州中医药大学第二附属医院(广东省中医院)胃肠外科,硕士研究生510120 [2]广东省中医院胃肠外科,广州市510120

出　　处：《实用医学杂志》2017年第2期253-256,共4页The Journal of Practical Medicine

摘　　要：目的:探讨腹腔镜技术在顽固性粘连性肠梗阻治疗中的疗效及其安全性。方法:回顾性病例对照分析我科2011年1月至2016年1月,发作3次及以上的顽固性粘连性肠梗阻患者68例,经保守治疗缓解后予腹腔镜手术干预和继续随访观察,分腹腔镜手术组(32例)和观察组(36例),对比两种治疗方式复发率和安全性。结果:随访半年以上,腹腔镜手术组复发率明显低于观察组(18.8%vs.77.8%P<0.05);腹腔镜组:肠粘连病理分型主要为混合型、片状粘连型及索带卡压型,随访发现:混合型复发率(66.7%,4/6例)明显高于片状粘连型(10.0%,1/10例)以及索带卡压型(6.3%,1/16例)。结论:在顽固性粘连性肠梗阻的缓解期,腹腔镜手术是安全可行的,能有效降低顽固性粘连性肠梗阻复发率,手术疗效与粘连类型密切相关。Objective To evaluate the efficacy and safety of laparoscopic technique in the treatment ofrefractory adhesive intestinal obstruction. Methods In a retrospective matched-pair analysis, 68 patients of re-fractory adhesive intestinal obstruction whose relapsed more than 3 times were included in the research. All patientswere treated with laparoscopic operation or continued follow-up observation after conservative treatment from Janu-ary 2011 to January 2016. The patients were divided into 2 groups, laparoscopic surgery（32 cases） and observationgroup（36 cases）, to contrast the recurrence rate and safety of the two types of treatment. Results The recurrencerate of laparoscopic surgery group was significantly lower in the observation group（18.8% vs. 77.8%, P 〈0.05）. Re-fractory adhesive intestinal obstruction is further divided into Mixed type, Patchy adhesion type and Cable Belt Com-pression type, in the laparoscopic surgery subgroup analysis, hybrid recurrence rate（66.7%, 4/6 cases） was signifi-cantly higher than that of patchy adhesion type（10.0%, 1/10 cases） and cord compression type（6.3%, 1/16 cases）.Conclusion Laparoscopic operation is safe and feasible in the treatment of refractory adhesive intestinal obstruc-tion, and then it can effectively reduce the recurrence rate of refractory adhesive intestinal obstruction; the curativeeffect is closely related to the type of adhesion.

关 键 词：腹腔镜手术 顽固性 粘连性肠梗阻 病理类型 

分 类 号：R656[医药卫生—外科学]