一次性腹腔镜保护套在肠梗阻封闭式肠外减压术中应用  

Application of Disposable Laparoscopic Protective Cover in Intestinal Obstruction Decompression Surgery

作　　者：蔡权 宫毅[1] 黄江生[1] CAI Quan;GONG Yi;HUANG Jiang-sheng(Department of Minimal Invasive Surgery, the Second Xiangya Hospital of Central South Univesity, Changsha 410011, Hunan, China)

机构地区：[1]中南大学湘雅二医院微创外科,长沙410011

出　　处：《中国现代手术学杂志》2018年第1期6-9,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨一次性腹腔镜保护套在肠梗阻封闭式肠外减压术中的应用价值。方法通过回顾性分析实验组(术中采用腹腔镜保护套行封闭式肠外减压)与对照组(术中采用传统双层纱垫保护肠管行开放式肠外减压)的临床资料。实验组共32例,男性19例,女性13例;平均年龄为(58.45±17.97)岁;原发疾病:大肠肿瘤22例,术后粘连6例,小肠肿瘤3例,小肠扭转1例;梗阻部位:结直肠22例,小肠10例;手术方式:一期肠吻合21例,肠造瘘11例。对照组为同期术中常规采用双层纱布垫行开放式肠外减压的161例患者,其中男性103例,女性58例;平均年龄为(59.38±13.79)岁;原发疾病:大肠肿瘤90例,术后粘连43例,小肠肿瘤4例,粪石梗阻4例,小肠扭转3例,克罗恩病4例,肠结核3例,腹股沟疝4例,小肠内疝3例,脾曲综合征1例,腹茧症1例,回盲部胚胎残余囊肿1例,梗阻部位:结直肠91例,小肠70例;手术方式:一期肠吻合110例,肠造瘘51例。比较两组患者手术时间、术后切口及腹腔感染、术后肺部感染、肠吻合术后吻合口漏、造瘘口严重水肿及造瘘口周围感染等方面的差异。结果对照组患者161例在手术后有45例患者(27.95%)的伤口、腹腔发生感染,而同期实验组患者32例患者有3例(9.37%)出现感染,两组比较,差异具有统计学意义(P<0.05)。观察组和对照组的手术时间为(188.44±37.27)vs.(176.71±47.29),肺部感染率为6.25%(2/32)vs.10.56%(17/161),肠吻合术后吻合口漏发生率为3.12%(1/32)vs.3.11%(5/161),肠造瘘口并发症发生率为0 vs.3.11%(5/161),两组比较均无统计学差异(P>0.05)。结论利用一次性腹腔镜保护套行肠梗阻封闭式肠外减压术能明显减少术后患者切口及腹腔感染的发生。Objective To investigate the value of disposable laparoscopic protective cover in closed external decompression for intestinal obstruction. Methods From May 2010 to Aug 2017,193 patients with intestinal obstruction were treated by external decompression. Among them,there were 32 cases underwent closed external decompression with disposable laparoscopic protective cover as the trial group,and161 cases were taken conventional external decompression. The clinical data were reviewed retrospectively. In the trial group,there were 19 males and 13 females,with the average age of（58. 45 ± 17. 97）years. The primary diseases were 2 2 cases of large intestine tumor,6 cases of postoperative adhesion,3 cases of small intestine tumor,1 case of small intestine twisting. The obstruction level was at the colorectal in22 cases and at the small intestine in 10 cases. In the control group,there were 103 cases of male and 58 women,with an average age of（59. 38 ± 13. 79） years. 90 cases of large intestine tumor,43 cases of postoperative adhesion,4 cases of small intestinal tumor,4 cases of fecal obstruction,3 cases of small intestinal torsion and 4 cases of Crohn＇s disease,3 cases of intestinal tuberculosis,4 cases of inguinal hernia,3 cases of intrenteral hernia,1 cases of splenic flexure syndrome,1 cases of abdominal cocoon,1 case of residual cyst of the ileocecal embryo.The obstruction level was at the colorectal in 91 cases and at the small intestine in 70cases.It was compared between the two groups of operation time,abdominal cavity infection and wound infection,lung infection,anastomotic leakage and complications of fistula.Results There were 45 patients whose wounds and（or）abdomen were infected in the control group,while 3 patients whose wounds and（or）abdomen were infected in the observation group,and the difference was statistically significant（P〈0.05）.Operation time of the trial group and the control group was（188.44±37.27）vs.（176.71±47.29）,and the pulmonary infection rate was 6.25%（2/32�

关 键 词：一次性腹腔镜保护套 肠梗阻 肠减压术 切口感染 

分 类 号：R735.3[医药卫生—肿瘤]