腹腔镜手术治疗肠梗阻技术难点及对策

Application strategies and technical difficulties of laparoscopic surgery in patients with intestinal obstruction

腹腔镜肠梗阻手术仍未普及,根源在于其手术难度大、风险高。首先,既往手术史或腹膜炎病史可能导致腹腔内广泛而致密的粘连;其次,弥漫性腹胀、肠管扩张使腹腔内操作空间变狭小,器械使用及病灶探查均受到限制;再次,肠壁变薄弱及脆性而易造成损伤。同时,术者的自身技术能力、设备器械等条件也是制约该手术进一步发展的因素。大量研究及实践证明,在仔细选择病例、严格把握手术时机、谨慎术中操作的前提下,腹腔镜肠梗阻手术并发症发生率和中转开腹率均在可接受的范围。根据不同的梗阻病因采取相应的手术策略,完全能够达到微创治疗的目的。

Laparoscopic operation in intestinal obstruction has not been used widely. The basic reason lies in its big difficulty and high risk. The previous operation history or the history of peritonitis could lead to extensive intra-abdominal dense adhesions. Diffused abdominal distension and bowel dilatation will make the space of intra-abdominal operation smaller. The using of the appliance and the exploration of lesions are restricted. The weak and brittle intestine wall is easy to be damaged. At the same time the doctor＇ s technology ability, the equipment and other conditions are also the factors that restricting the further development of the operation. A large number of literatures and clinical practices have proved that in the basis of selecting patients carefully and grasping the operation time strictly and operating carefully, the complications and the conversion rate were acceptable. Adopting varied operation strategies according to different causes of obstruction could realize the purpose of minimally invasive treatment.