腹腔镜技术在腹部闭合性损伤诊断与治疗中的应用研究

Application of laparoscopy in the diagnosis and treatment of closed abdominal trauma

目的:探讨腹腔镜技术在腹部闭合性损伤诊断与治疗中的应用价值。方法:回顾分析2013年1月至2015年12月应用腹腔镜技术诊治65例腹部闭合性损伤患者的临床资料。结果:术中发现,8例(12.3%)患者无明确脏器组织损伤,19例(29.2%)为轻微损伤但无需特殊处理,23例(35.4%)仅需腹腔镜下止血、修补或放置引流等简单处理,15例(23.1%)需要腹腔镜下(n=10)或中转开腹(n=5)完成脏器切除手术。未发生术后再出血与消化道瘘,无围手术期死亡。术后发生切口感染、腹腔脓肿、早期炎性肠梗阻各1例,均为中转开腹患者。结论:腹腔镜技术有助于腹部闭合性损伤的早期诊断,明显减少了不必要的剖腹探查,对于术中发现的腹部脏器损伤,腹腔镜技术可进行及时、安全、有效的处理。

Objective： To explore the application value of laparoscopy in the diagnosis and treatment of closed abdominal trauma. Methods： From Jan. 2013 to Dec. 2015,the clinical data of 65 patients with closed abdominal trauma treated by laparoscopy were retrospectively analyzed. Results： In the series of 65 cases,no significant injuries were identified in the 12. 3% of the patients（ n = 8）upon an initial laparoscopic survey. 29. 2%（ n = 19） cases were minor injuries and had nontherapeutic procedures. The 35. 4%（ n =23） of the patients were only performed simple processing such as hemostasis,repair or drainage by laparoscopy. Only 23. 1%（ n = 15）of the patients needed laparoscopic operation（ n = 10） or conversion to laparotomy（ n = 5） to complete organ excision. There was no postoperative bleeding or digestive tract fistula,and no death in perioperative period. Three cases of postoperative incision infection,abdominal abscess,and early inflammatory intestinal obstruction occurred in the patients converted to open surgery. Conclusions： The laparoscopic technology is helpful to the early diagnosis of closed abdominal trauma and significantly reduces the unnecessary laparotomy.It can be performed timely,safely and effectively in the treatment of abdominal organs injury which are found during the exploratory process.