摘要
目的探讨腹腔镜探查在病因不明的复杂外科急腹症患者中的应用价值。方法将本院收治的病因不明的复杂外科急腹症患者分为腹腔镜探查手术组(腹腔镜组)、中转开腹组及开腹探查手术组(开腹组),比较3组临床资料。结果共纳入77例,所有患者经开腹探查(n=39)和腹腔镜探查(n=38)后明确诊断,其中消化道穿孔42例、肠梗阻9例、外伤7例、肠憩室4例、肠系膜病变5例、胆囊炎伴穿孔2例、肠套叠4例、嵌顿疝1例、其他3例。最终腹腔镜手术26例,12例中转开腹手术,开腹探查并行手术治疗39例。3组患者性别、年龄和原发疾病方面无显著差异。腹腔镜组手术时间、术中出血量和住院费用显著少于开腹组。与开腹组相比,腹腔镜组消化道穿孔手术时间相对较短,术后并发症发生率显著低于开腹组(P <0. 05)。在肠梗阻患者中,开腹组年龄显著大于其他2组(P <0. 05),手术时间显著长于其他2组(P <0. 05)。结论对诊断不明的复杂外科急腹症患者,腹腔镜操作安全可靠,可缩短手术时间,减少术后并发症的发生,有利于患者快速康复。
Objective To explore the clinical value of laparoscopic exploration in treatment of patients with agnogenic complex surgical acute abdomen. Methods The patients with agnogenic complex surgical acute abdomen were divided into laparoscopic exploration group (laparoscopic group), conversion to laparotomy group and laparotomy exploration group (laparotomy group). The clinical materials were compared among three groups. Results A total of 77 patients were enrolled. All patients were diagnosed by open laparotomy ( n =39) or laparoscopic exploration ( n =38), including 42 cases with gastrointestinal perforation, 9 cases with intestinal obstruction, 7 cases with trauma, 4 cases with intestinal fistula, 5 cases with mesenteric lesions, 2 cases with cholecystitis and perforation, 4 cases with intussusception, 1 case with incarcerated hernia, and 3 cases with other complications. Finally, there were 26 cases with laparoscopic surgeries, 12 cases with conversion to open laparotomy, and 39 cases with open laparotomy exploration and surgery. There were no significant differences in gender, age and primary diseases among the three groups. The operation time, intra-operative bleeding volume and hospitalization expenses of laparoscopic group were significantly less than those of laparotomy group. Compared with the laparotomy group, the laparoscopic group had shorter operation time for digestive tract perforation, and the incidence rate of postoperative complications was significantly lower than that of the laparotomy group ( P <0.05). In patients with intestinal obstruction, the age of the laparotomy group was significantly larger than that of the other two groups ( P <0.05), and the operation time was significantly longer than that of the other two groups ( P < 0.05). Conclusion Laparoscopic operation is safe and reliable forpatients with agnogenic complex surgical acute abdomen, which can shorten the operation time, reduce the occurrence of postoperative complications, and promote recovery of patients.
作者
韩聪
翁延宏
张华
叶小利
朱永龙
HAN Cong;WENG Yanhong;ZHANG Hua;YE Xiaoli;ZHU Yonglong(Department of General Surgery, Huangshan Shoukang Hospital, Huangshan, Anhui 245000)
出处
《实用临床医药杂志》
CAS
2019年第6期80-84,共5页
Journal of Clinical Medicine in Practice
关键词
腹腔镜
探查
急腹症
病因
消化道穿孔
肠梗阻
laparoscopy
exploration
acute abdomen
etiology
gastrointestinal perforation
intestinal obstruction
