开腹手术、高频电刀与超声刀治疗粘连性肠梗阻疗效分析

Treatment effectiveness of ultrasonically activated scalpel,high frequency electrotome under laparoscopy and laparotomy for adhesive intestinal obstruction

目的比较开腹手术、高频电刀与超声刀治疗粘连性肠梗阻的临床效果,探讨粘连性肠梗阻手术方式以及腹腔镜治疗肠粘连的优越性。方法回顾性分析1999年6月至2010年6月应用超声刀治疗粘连性肠梗阻27例及高频电刀手术治疗粘连性肠梗阻23例患者的临床资料,并与同期30例开腹手术对比分析。结果平均手术时间超声刀组为(62.1±17.7)min,高频电刀组为(98.0±37.0)min,开腹手术组为(115.0±20.2)min。与另外两组比较,超声刀组手术时间显著降低;与开腹手术组比较,高频电刀组手术时间显著下降(P<0.01)。3组平均术中出血量分别为(13.9±4.4)ml、(35.0±6.4)ml和(150.0±35.0)ml,超声刀组低于另外两组,高频电刀组低于开腹手术组差异有统计学意义(P<0.01)。平均术后住院时间分别为(3.2±0.5)d、(6.1±1.0)d和(11.8±4.0)d,超声刀组与高频电刀组显著低于开腹手术组(P<0.01)。超声刀组无一例发生并发症,高频电刀组发生2例,开腹组发生7例,组间差异有统计学意义(P<0.05)。结论超声刀及高频电刀治疗粘连性肠梗阻具有创伤小、术后康复快、并发症少及住院时间短等优点。超声刀治疗效果优于高频电刀。

Objective To assess the value of ultrasonically activated scalpel and high frequency electrotome under laparoscopy and laparotomy in treatment of adhesive intestinal obstruction. Methods Clinical data of twenty-seven adhesive intestinal obstruction patients operated by ultrasonically activated scalpel under laparoscopy in our hospital from Jun. 1999 to Jun. 2010 were retrospectively analyzed and they were compared with 23 patients who underwent electroscalpel enterolysis and 30 cases who underwent laparotomy at the same period. Results The operative duration were （62.1 ± 17.7）min in the group of uhrasonically activated scalpel, （98.0 ±37.0）min in the group of electroscalpel enterolysis, and （115.0± 20.2） min in the group of laparotomy. The volume and time were remarkably descendent in the group of ultrasonically activated scalpel comparing to the group of electroscalpel enterolysis. So it was in the group of electroscalpel enterolysis, comparing to the group of laparotomy （P〈 0.01）. Mean bleeding were （13.9± 4.4）ml, （35.0 ±6.4）ml and （150.0 ± 35.0）ml, respectively. And the mean length of stay were （3.2±0.5）d, （6.1 ±1.0）d and （11.8 ±4.0）d, which was remarkably descendent in the group of ultrasonically activated scalpel or electroscalpel enterolysis comparing to the group of laparotomy （P 〈 0.01 ）. There was no complication in the group of ultrasonically activated scalpel, 2 cases happened in the group of electroscalpel enterolysis and 7 cases in the group of laparotomy. They were remarkably differential in groups （P〈 0.05）. Conclusions Enterolysis using laparoscope and ultrasonically activated scalpel to treat adhesive intestinal obstruction is safe and feasible. It has the advantages of short operative time and hospital stay, less invasion and complications, and lower recurrence rate.