摘要
目的:总结腹腔镜手术治疗胃肠道穿孔的手术方法及应用价值。方法:回顾分析为20例胃肠道穿孔患者行腹腔镜手术的临床资料。术中探查腹腔,吸净腹腔积液,行穿孔修补术。结果:19例顺利完成腹腔镜手术,1例胃穿孔患者术中见胃壁僵硬发白,冰冻检查确诊为胃癌,遂中转开腹行胃癌根治术(D1)。手术时间60～120 min,平均90 min;术后48～96 h恢复胃肠蠕动后拔除胃管、引流管、尿管,开始进流质饮食,并逐渐恢复正常饮食。术后无并发症发生。术后3个月行胃镜、结肠镜检查及全消化道钡餐透视,随访6～12个月,无一例复发或明显异常。结论:腹腔镜胃肠道穿孔修补术操作简单、安全、效果确切,不受患者肥胖因素影响,可充分吸净腹腔内积液,减少了术后腹腔、盆腔脓肿的发生,对腹腔脏器干扰小,术后粘连性肠梗阻发生率低;同时可明确诊断,避免了盲目开腹手术切口相关并发症的发生,较传统开腹手术更具优越性,值得临床推广。
Objective ： The purpose of this study is to summarize the operative method and application value of laparoscopic op- eration for gastrointestinal tract perforation. Methods： The clinical data of 20 gastrointestinal tract perforation patients who were performed laparoscopic operation were retrospectively analyzed. The abdominal cavity was explored in operation, the effusion in abdominal cavity was aspirated, repair of perforation was performed. Results ： Nineteen cases of laparoscopic operation were successfully performed. The gastric wall of one gastric perforation patient was found rigid and pale, stomach cancer was diagnosed by rapid pathologic examination. This case was converted to open radical gastric cancer operation（ D1）. The operative time was 60-120 rain （mean 90 min）. The gastrointestinal function recovered 48-96 h after operation, the gastric tube, drainage tube and urinary canal were removed, fluid food was given to patients, and normal diet was gradually resumed. No complications were found after operation. Gastroscopy, colonoscopy and gastrointestinal barium meal examination were performed 3 months after surgery. During the follow-up of 6-12 months,no recurrence or obvious abnormality was found. Conclusions：Laparoscopic repair of gastrointestinal perforation is easy, safe and effective with little interference to abdominal organ, obesity can not disturb the procedure, effusion in abdominal cavity can be aspirated completely, postoperative abdominal and pelvic cavity abscess, and adhesive intestinal obstruction incidence decreases. The diagnosis can be identified at the same time, incision related complications following blind laparotomy can be avoided. This procedure is superior than traditional laparoto- my, and is worthy of clinical generalization.
出处
《腹腔镜外科杂志》
2012年第6期427-429,共3页
Journal of Laparoscopic Surgery
