腹腔镜技术在急性肠系膜血管缺血性疾病诊疗中的应用  

Application of laparoscopy in the management of acute mesenteric ischemia

作　　者：张小桥 张庆钊 Zhang Xiaoqiao;Zhang Qingzhao(Department of Gastrointestinal Surgery,Shandong Provincial Hospital Affiliated to the Shandong First Medical University,Ji′nan 250021,China;First Department of Surgery,Traditional Chinese Medicine Hospital of Xintai City of Shandong Province,Xintai 271200,China)

机构地区：[1]山东第一医科大学附属省立医院(山东省立医院)胃肠外科,济南250021 [2]山东新泰市中医医院外一科,新泰271200

出　　处：《国际外科学杂志》2022年第12期797-801,共5页International Journal of Surgery

摘　　要：准确判断肠管活力是急性肠系膜血管缺血性疾病诊疗中的关键之一。对部分患者而言,通过腹腔镜探查或初次手术后的再次探查来明确肠管坏死的有无,较之剖腹探查手术创伤更小,既能够及时发现肠管坏死等病情,又能够有效避免阴性剖腹探查的损伤,减轻手术创伤的不良反应,对危重患者实施床边腹腔镜检查还能够有效避免转运过程中的风险。联合应用术中荧光造影术能够弥补单纯肉眼观察的不足,更加客观、准确地判断肠管的血运情况。因此,对难以确定肠管血运状况、存在肠管坏死风险的急性肠系膜血管缺血性疾病患者,联合应用血管腔内治疗技术和腹腔镜技术能够更为准确、更加微创地判断病情,从而更加精准地实施治疗,在一定程度上提高救治效果,改善患者预后。Accurate determination of intestinal viability is the key step in the management of acute mesenteric ischemia.For patients with the possibility of intestinal necrosis,the application of laparoscopy for the primary exploration or second look,is significantly less invasive than laparotomy,so to avoid the unnecessary operative trauma for those with negative results.For critical patients,application of bed-side laparoscopy,with the avoidance of risks during transport process,is an effective and safer diagnostic method.And the combination with intraoperative indocyanine green fluorescence angiography may further improve the reliability of exploration so to result in more precise surgical management for these severe situation.So in the era of endovascular management for acute mesenteric ischemia,as an mimmally invasive and precise method for accurate determination of existence or not of intestinal necrosis,laparoscopy is effective in further improving the outcome of these patients.

关 键 词：腹腔镜 肠系膜 缺血 荧光造影术 

分 类 号：R656[医药卫生—外科学]