腹腔镜手术在闭合性腹外伤中的应用

Application of laparoscopic operation in closed abdominal trauma

目的 探讨腹腔镜手术在闭合性腹外伤中的价值。方法 2003年12月～2006年7月腹腔镜诊治47例闭合性腹外伤。在全麻或硬膜外麻醉下,脐下做1 cm小切口,根据病人的具体情况选用气腹针或通过开放性通道建立人工气腹。未明确诊断者可适当置1～2个trocar配合探查;若明确诊断,根据病灶位置选择操作孔位置,一般2～3个。根据病变情况再做相应处理。结果 47例经腹腔镜手术明确诊断：肝破裂15例,脾破裂13例,小肠破裂9例,肠系膜损伤3例,胰腺损伤2例,腹膜后血肿2例,腹内多脏器损伤3例。腹腔镜下完成手术28例,17例中转开腹,2例诊断为腹膜后血肿无须处理。47例随访6个月无并发症发生。结论 腹腔镜下可明确诊断闭合性腹外伤,使患者得到及时、有效、合理的治疗。

Objective To investigate the value of laparoscopic operation in the diagnosis and treatment of closed abdominal injury. Methods Forty-seven cases of closed abdominal trauma were diagnosed and treated under laparoscope from December 2003 to July 2006. Under general anaesthesia or epidural anesthesia, an incision about 1 cm was made below the umbilicus. Then artificial pneumoperitoneum was established through an open tunnel or the veress needle （ according to patient＇ s condition）. The camera was inserted through a trocar to clarify the diagnosis. If a confirmative diagnosis was not obtained, one or two additional trocars were inserted for further exploration. When the diagnosis was identified, another two or three trocars were inserted according to the location of lesions and corresponding treatment was performed based on pathogenetic condition. Results All the 47 cases were confirmatively diagnosed under laparoscope, including 15 cases of hepatorrhexis, 13 cases of splenic rupture, 9 cases of small intestinal rupture, 3 cases of mesenteric injury, 2 cases of pancreatic injury, 2 cases of retroperitoneal hematoma, and 3 cases of intraabdominal multiple organ injury. Laparoscopic treatment was completed in 28 cases, a conversion to open surgery was needed in 17 cases, and conservative treatment was given in 2 cases of retroperitoneal hematoma. No surgical related death or complications happened. Conclusions Laparoscopy can be used in closed abdominal trauma to achieve a high diagnostic accuracy and to give a timely, effective, and proper treatment.