腹腔镜诊治多发伤合并腹部创伤

Laparoscopy in diagnosis and treatment of abdominal trauma in p atients with multiple injuries

目的探讨腹腔镜在多发伤合并腹部创伤诊治中的价值。方法收集近两年来,本院急诊科为尽早作出诊断并给予确定性治疗而应用腹腔镜技术诊治的31例多发伤合并腹部创伤病例的临床资料,与21例传统剖腹探查病例的临床资料比较,对腹腔镜在腹部创伤诊治中的时效性、诊断率、治疗率、非治疗性手术率等方面进行分析。结果共有31例多发伤合并腹部创伤患者在急诊科接受了腹腔镜手术,均未因临床观察而耗损时间。术前耗时(61·5±9·2)min,比剖腹组(180·5±99·5)min明显缩短(P<0·01);其中28例在腹腔镜下明确诊断(占90·3%),21例在腹腔镜下完成治疗(占67·7%),4例得以明确诊断但不需特别处理(占12·9%),中转开腹6例(占19·4%)。术后肠鸣音恢复时间为(2·2±0·9)d,比剖腹组的(3·1±1·0)d明显缩短(P=0·001)。未发生腹腔镜相关并发症。结论腹腔镜手术对多发伤合并的腹部损伤能及时作出正确诊断并给予确定性治疗,提高抢救时效,加快患者康复。

Objective To study the effect of laparoscopy in diagnosis and treatment of abdominal trauma in patients with multiple injuries. Methods The clinical data of patients with multiple injuries, including 31 who received laparoscopy and 21 treated with laparotomy for abdominal trauma in our department in the recent two years, were retrospectively analyzed. Results Thirty-one patients were treated with laparoscopy had less treatment delay. Interval between admission and operation in laparoscopy group was （61.5 ± 9.2） minutes, significantly less than that in laparotomy group （180.5 ＋ 99.5） minutes （P 〈 0.001）. Twenty-eight patients （90.3%） were diagnosed correctly, and 21（67.7 % ） treated successfully. The time of bowel sound recovery after operation in laparoscopy group was （2.2 ± 0.9）days significantly shorter than that in laparotomy group （3.1 ＋ 1.0） days （P = 0.001）. No complications associated with laparoscopy occurred in all patients. Conclusion Laparoscopy improves efficiency of diagnosis and treatment of abdominal trauma in patients with multiple injuries, and so accelerates patients＇ recovery.