下腹部手术史盆腹腔粘连妇科腹腔镜手术86例分析

Laparoscopic operation in abdominal or pelvic adhesion due to post-operation on low abdomen: 86 cases report

目的探讨下腹部手术史妇科腹腔镜手术中盆腹腔粘连的处理措施及其安全性。方法回顾性分析该院86例腹部手术史行妇科腹腔镜手术时盆腹腔粘连情况,根据术中粘连情况进行评定分为Ⅰ～Ⅵ级,Ⅰ、Ⅱ级为轻度粘连组,≥Ⅲ级为重度粘连组,并总结腹腔镜在处理手术后盆腹腔粘连的经验。结果轻度粘连组与重度粘连组比较,手术时间(84±29)min明显短于重度粘连组(116±59)min,P<0.05;两组中转开腹率均为(0);轻度粘连组术中出血量(48±39)mL、术后住院天数(3.48±1.03)d、术后病率3.2%,与重度粘连组术中出血量(56±48)mL、术后住院天数(3.5±1.0)d、术后病率4.1%相比,差异无显著性,P>0.05,两组均无手术并发症发生。结论用腹腔镜处理下腹部手术后盆腹腔粘连时,除个别肠管广泛致密粘连外,对绝大部分病人来说是安全可行的。

[Objective] To learn the efficacy and safety of laparoscopic operation in abdominal or pelvic adhesion due to post-operation on low abdomen. [Method] Data of 86 cases with abdominal or pelvic adhesion due to post-operation on low abdomen, who were performed laparoscopic operation, were retrospectively analyzed. They were divided into mild group ( including Ⅰ and Ⅱ degree ) and severe group (including Ⅲ and Ⅳ degree). [Results] The operation time in mild group was obviously shorter than in severe group (84±29) min vie (116±59) min, (P <0.05), however, the amounts of bleeding, durations in ward, fever after operation in mild and severe group were not significant difference (48±39) mL vie (56±48) mL, (3.48±1.03) d, 3.2% vie 4.1%, respectively. No patient transferred to normal abdominal operation due to laparoscopic operation failed. Not any complication in both group was seen. [Conclusion] Laparoscopic operation is effective and safe on the patient with abdominal or pelvic adhesion except very serious intestinal adhesion.