开腹手术与腹腔镜手术治疗CASBO的临床疗效分析

Clinical analysis of laparotomy and laparoscopic surgery in treating CASBO

目的探讨开腹手术与腹腔镜手术治疗慢性粘连性肠梗阻(CASBO)的临床疗效与安全性系统评价,为临床治疗CASBO提供有效依据。方法回顾性分析2014年1月至2015年12月接受治疗的90例CASBO患者,分为腹腔镜手术组(腹腔镜组)和传统开腹手术组(开腹组),每组45例。采用SPSS 22.0统计学软件进行分析,术中术后指标均用均数±标准差表示,运用t检验方法进行组间比较;术后并发症的发生率以(%)表示,采用χ~2检验,P<0.05代表差异具有统计学意义。结果研究发现腹腔镜组的治疗有效率明显高于开腹组(χ~2=3.852,P=0.018)。腹腔镜组患者的出血量、手术时间、排气时间及住院时间等指标均显著低于开腹组,差异具有统计学意义(t=3.962,P=0.015;t=4.226,P=0.008;t=3.886,P=0.012;t=4.018,P=0.004)。腹腔镜组患者的术后并发症的总发生率4.4%显著低于开腹组33.3%,差异具有统计学意义(t=4.552,P=0.014)。术后不同时间段两组患者在生活质量方面均有改善,且腹腔镜组的评分在手术3个月和6个月后明显高于开腹组,差异具有统计学意义(t=3.572,P=0.033;t=3.911,P=0.016)。结论腹腔镜手术对于CASBO具有快速、有效、分辨率高及安全性好的疗效,具有较高的临床应用价值。

Objective To explore the clinical curative effect and the safety of laparotomy and laparoscopic surgery in treating chronic adhesive small bowel obstruction（CASBO） , to provide the effective basis of the clinical treatment for the CASBO. Methods From Jan 2014 to Dec 2015, 90 patients with CASBO were enrolled in this study, including 45 cases in laparoscopic surgery group and 45 cases in laparotomy group. Statistical analysis were performed by using SPSS version 22.0 software. The measurement data such as perioperative indicators were expressed as x ± s, and were examined by using t test. Count data such as complication rate were examined by using χ2 test , A P value 〈 0.05 was considered as statistical- ly significant difference. Results Clinical outcome in laparoscopic group was better than that in laparoto- my group （χ2 = 3. 852, P = 0. 018）. Blood loss, operating time, exhaust time and hospital stay were significantly lower in laparoscopie group than those in laparotomy group respectively, with significant difference （t =3.962, P=0. 015; t =4.226, P0.008, t =3.886, P=0. 012, t =4.018, P =0.004）. Incidence of postoperative complications in laparoseopic group was 4.4% , which was significantly lower than 33.3% in laparotomy group, with significant difference （t = 4. 552, P = 0. 014）. In both 2 groups, patients＇ quality of life were all improved after the surgery, while score in laparoscopic group was significantly higher than those in laparotomy group on post operation 3 months and 6 months respectively （ t = 3. 572, P = 0. 033 ; t = 3.911, P = 0. 016）. Conclusion The laparoscopic surgery had advantages of fast, efficient, high resolution with safety, which is worth of clinical promotion in treating CASBO.