应用腹腔镜对腹部闭合性损伤的诊断及治疗优势

The advantages of laparoscopy in diagnosing and treating the abdominal closed injury

目的探讨腹腔镜在腹部闭合性损伤中的诊断及治疗优势。方法对比分析46例腹部闭合性损伤患者传统开腹和应用腹腔镜进行诊断与手术治疗的方法和效果。结果传统开腹组24例均明确诊断,手术切口长度平均15cm,术后1例切口哆开二次缝合,2例切口感染。腹腔镜探查组22例全部明确诊断,术后肠道功能恢复时间、平均住院日均短于传统开腹组(P<0.01);其中11例同时进行治疗,7例无需手术处理,避免了不必要的开腹手术,4例诊断明确后中转开腹取相应手术部位小切口,无并发症和死亡病例。结论应用腹腔镜诊治腹部外伤具有创伤小、安全可靠、诊断率高等优点,并有效降低阴性剖腹探查率,适用于大部分腹部外伤的病例。对于术前确诊的伴有严重失血性休克的肝、脾、肾重度损伤的病例,基于目前的医学水平暂不主张采用腹腔镜探查。

Objective To investigate the advantages of laparoscopy in diagnosing and treating the abdominal closed injury. Methods We compared the diagnosis and operation effect of 46 cases with abdominal closed injury by using the two methods of opening abdomen and laparoscopy. Results Among 24 cases in the opening abdomen group,the diagnoses were clear,the average length of surgical incision was about 15 cm, 1 case was made second postoperative saturation ,2 cases suffered from postoperative infection. Among 22 cases in the laparoseopic approach group, all the diagnoses were clear; the time of postoperative intestinal functional rehabilitation and hospitalization were shorter than those of the traditional group（ P 〈 0.01 ）. 11 cases were treated at the same time,7 cases did not need surgery and avoided unnecessary laparotomy. After clear diagnosis,4 cases were made laparotomy with small incision and there were no complications and death. Conclusion The diagnosis and treatment of the abdominal closed injury with laparoscopy have the advantages of small trauma, safety and high diagnosis rate and can reduce the negative laparotomy rate,which can be applied in most cases of abdominal trauma. For the cases who have been made clear preoperative diagnosis of hemorrhagic shock with severe injury in liver, spleen and kidney,we dont advocate to use the laparoscopic approach aceordig to the current medical level.