腹腔镜在小肠出血诊治中的临床应用

Application of laparoscopy in diagnosis and treatment for small intestinal bleeding

目的：评价腹腔镜在小肠出血诊治中的临床应用价值。方法：回顾性分析2003年9月至2007年6月行腹腔镜诊治的55例小肠出血患者的临床资料，并对手术时间、术中失血、切口长度、术后排气时间、术后住院天数、并发症、术后病理和随访结果进行统计学分析。结果：腹腔镜探查不仅明确了所有患者小肠出血的原因，而且同时实施了相应的腹腔镜手术，其中包括7例完全腹腔镜下小肠肿瘤局部切除术；10例腹腔镜下小肠憩室切除术；37例腹腔镜辅助下小肠肠段切除术；1例腹腔镜辅助下右半结肠切除术。腹腔镜平均手术时间（70．0±28．6）min，术中平均失血（13．5±10．2）ml，平均切口长度（3、4±1.3）cm，平均术后排气时间为（2、2±0.8）d，术后平均住院（7.8±2．9）d。2例（3．6％）术后分别出现吻合口糜烂出血和束带粘连性小肠梗阻。术后随访29（5～50）个月，无复发病例。结论：腹腔镜技术在小肠出血诊治中具有良好效果，腹腔镜小肠手术是一种安全、有效的微创手术方法，值得临床推广应用。

Objective： To evaluate the effect of laparoscopy in diagnosis and treatment for the patients with small intestinal bleeding. Methods ： The clinical data of patients with small intestinal bleeding underwent laparoscopic diagnosis and treatment from Sep 2003 to Jun. 2007 in our hospital were retrospectively analyzed with the operative time, blood loss, length of incision, the time for passage of flatus, post-operative hospitalization and operative complications. Results：All 55 patients were diagnosed and treated by laparoscopic procedure successfully including 7 laparoscopic intestinal local resections, 10 laparoscopic intestinal diverticular resections,37 laparoscopic partial intestinal resections and 1 laparoscopic fight hemieolectomy. The mean operative time was （70.0±28.6）min, blood loss was （ 13.5± 10.2） ml, length of incision was （3.4 ± 1.3 ） cm, time for passage of flatus was （2.2 ±0.8 ） d and the post-operative hospitalization was （7.8±2.9）d. 2 patients （3.6%）with operative complications occurred with anastomosis bleeding and adhesional intestinal obstruction. After 29 （ 5-50 ） months following-up, no recurrent eases were found. Conclusions： Laparoscopy is a very useful and minimally invasive technique in the diagnosis and treatment of small intestinal bleeding. It is simple, safe, effective and worthy of be clinically applied.