腹腔镜诊治粘连性肠梗阻11例报告

Laparoscopy in diagnosis and treatment of adhesive intestinal obstruction:with a report of 11 cases

目的:探讨腹腔镜诊断与治疗粘连性肠梗阻的可行性。方法:回顾分析我院应用腹腔镜手术治疗11例粘连性肠梗阻患者的临床资料。结果:11例均确诊为粘连性肠梗阻,其中肠道相互粘连4例,粘连束带卡压小肠4例,肠道与切口粘连成角3例。2例因肠道明显弥漫性扩张,腹腔镜腹内无探查空间中转开腹,余均在腹腔镜下顺利完成手术。手术时间55～206min,平均123min,术后肠鸣音恢复时间18～59h,平均37h,术后24h患者可下床活动,切口均甲级愈合,住院时间5～8d,平均7.1d,随访1～24个月,平均8个月,无复发。结论:在选择适宜的患者,操作规范及把握好中转开腹指征的前提下,腹腔镜手术治疗粘连性肠梗阻安全可行,具有患者创伤小,术后康复快,远期效果好等优点,是传统开腹手术的有益补充和良好替代。

Objective： To investigate the feasibility of laparoscopy in diagnosis and treatment of adhesive intestinal obstruction. Methods：The clinical data of 11 patients who were diagnosed as adhesive intestinal obstruction and treated by laparoscopie operation were retrospectively analyzed. Results： The definite diagnosis of adhesive intestinal obstruction was made in all the 11 cases. 4 of them were intestinal adhesion,4 cases were adhesive band compressing intestine, and 3 cases were adhesion angulafion between bowel and in- cision. 2 cases were converted to laparotomy because of significantly diffuse dilation of bowel and there was not enough space for laparo- scopic abdominal exploration. The other patients underwent laparoscopic operation. The mean operative time was 123min （range 55- 206min） ,the mean recovery time of bowel tones was 37h （range 18-59） , patients could freely walk in 24h postoperatively, the healing of incisions were first grade, and the hospital stay was 5-8d with a mean of 7.1 d. Furthermore the mean follow up was 8 months （range 1-24 months）, and no recurrence of intestinal obstruction was found. Conclusions：In the premise of eligible indication, standard procedures and proper choice of conversion to laparotomy, laparoscopy in diagnosis and treatment of adhesive intestinal obstruction is safe and feasible, has advantages of less trauma, quicker recovery and better long-term effect, and is a beneficial supplement and fine alternative of traditional open surgery.