腹腔镜联合肠梗阻导管治疗复杂性粘连性肠梗阻的可行性分析  

Feasibility Analysis on Laparoscopic Surgery combined with Ileus Tube in Treatment of Complicated Adhesive Small Bowel Obstruction

作　　者：张帅 徐靖[2] 石磊[3] 赵永捷[2] 江涛[2] 

机构地区：[1]天津市中医药大学研究生院,天津300193 [2]天津市人民医院普通外科,天津300121 [3]天津市人民医院内镜中心,天津300121

出　　处：《中国中西医结合外科杂志》2018年第1期54-57,共4页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:探讨腹腔镜联合经鼻肠梗阻导管治疗复杂性粘连性肠梗阻的可行性及潜在优势。方法:回顾性收集符合复杂性粘连性肠梗阻纳入标准、经鼻肠梗阻导管治疗后梗阻未缓解并行手术治疗者65例,随机分为腹腔镜治疗组31例,开腹手术治疗组34例。比较两组围手术期安全性及治疗效果间差异。结果:两组患者年龄、性别、ASA评分及手术史等一般资料比较差异均无统计学意义。31例腹腔镜探查患者共中转5例,34例行开腹手术治疗。在术后并发症率、排气时间、进食时间及术后住院时间方面,腹腔镜组优于开腹组,存在统计学差异(P<0.05)。腹腔镜组患者术后随访复发率(7.7%)低于开腹组(14.7%),具备统计学差异。结论:腹腔镜联合肠梗阻导管治疗复杂性粘连性肠梗阻安全、微创、效果可靠,可显著减低术后复发率,可作为复杂性肠梗阻的有效治疗方式。Objective To determine the feasibility and possible superiority of laparoscopic surgery combined with nasal insertion type ileus tube in the treatment of complicated adhesive small bowel obstruction. Methods Clinical data of 65 patients meeting the inclusion criteria for complicated adhesive small bowel obstruction who underwent endoscopic decompression and surgery were retrospectively reviewed. Patients were randomly divided into lapascopic surgery group （n=31） and laparotomy group （n=34）. The safety and efficacy of different surgical treatment were compared between two groups. Results There was no statistically signi？cant difference in baseline data between two groups （all P 〉 0.05）. Five of 31 patients in laparoscopic group were transformed to laparotomy, other 34 patients recieved laparotomy. In laparoscopic group, the exhaust time, eating time, complication rate and hospitalization time after operation were signi？cantly less than those in laparotomy group （P 〈 0.05）. There was also signi？cant difference in recurrence rate after operation between laparoscopic group and laparotomy group （ 7.7% vs 14.7%,P =0.043）. Conclusions Laparoscopic adhesiolysis combined with ilues tube is more safe, effective and less invasive in the treatment of complicated adhesive small bowel obstruction and could reduce the recurrence effectively.

关 键 词：腹腔镜 经鼻肠梗阻导管 复杂性粘连性肠梗阻 并发症率 复发率 

分 类 号：R574.2[医药卫生—消化系统]