腹腔镜探查术与剖腹探查术在腹部开放性损伤诊治中的对比研究

Comparison of laparoscopic exploration and exploratory laparotomy in the diagnosis and treatment of abdominal open trauma

目的探讨腹腔镜探查术对腹部开放性损伤患者的诊治疗效。方法选择2018年8月至12月大连医科大学附属第一医院收治的腹部开放性外伤患者,根据探查方式不同将11例行腹腔镜探查术的患者纳入腔镜组,20例行剖腹探查术的患者纳入剖腹组。对比两组患者手术时间、住院时间、未合并腹腔内脏损伤例数、肛门排气时间、并发症发生情况、切口长度。结果 31例患者均为刀刺伤;男性26例,女性5例;年龄(33.39±11.47)岁。与剖腹组比较,腔镜组患者住院时间明显缩短(d:6.64±2.94比11.65±5.62),肛门排气时间明显提前(h:40.36±29.04比75.60±42.84),并发症少(例:1比9),切口小(cm:5.50±5.14比16.95±5.28),差异均有统计学意义(均P<0.05);腔镜组手术时间较剖腹组有所缩短,但差异无统计学意义(h:2.18±0.87比2.61±1.28,P>0.05)。经手术探查证实,共5例患者未合并腹腔内脏损伤,其中腔镜组3例,剖腹组2例,两组比较差异无统计学意义(P>0.05)。结论对于腹部开放性损伤患者,采用腹腔镜探查术有利于尽快确诊病情,且手术创伤小,并可减少并发症,有利于术后康复。

Objective To explore the clinical effect of laparoscopic exploration in the diagnosis and treatment of abdominal open trauma. Methods Patients with abdominal open trauma admitted to the First Affiliated Hospital of Dalian Medical University from August to December in 2018 were enrolled. According to different exploration methods, 11 patients undergoing laparoscopic exploration were grouped into laparoscopy group and 20 patients undergoing exploratory laparotomy were grouped into laparotomy group. The operation time, the length of hospital stay, cases without abdominal visceral injury, postoperative exhaustion time, cases with complications and incision length were compared between the two groups. Results All the 31 patients were experienced with knife stab wound, with 26 males and 5 females, and the age was (33.39±11.47) years old. Compared with the laparotomy group, the length of hospital stay was significantly shorted in the laparoscopy group (days: 6.64±2.94 vs. 11.65±5.62), the postoperative exhaustion time was significantly decreased (hours: 40.36±29.04 vs. 75.60±42.84), the cases with complication was significantly decreased (case: 1 vs. 9), the incision length was significantly shorted (cm: 5.50±5.14 vs. 16.95±5.28), all of which results had statistical significance (all P < 0.05). The operation time of laparoscopy group was shorter than that of laparotomy group (hours: 2.18±0.87 vs. 2.61 ±1.28), but without significant difference (P > 0.05). Confirmed by surgical exploration, 5 patients had no abdominal visceral injury, with 3 in the laparoscopy group and 2 in the laparotomy group, and the result had no significant difference between the two groups (P > 0.05). Conclusion For patients with abdominal open trauma, laparoscopic exploration is helpful for diagnosis as quickly as possible, with less trauma and reduction of complications incidence, and is conducive to postoperative rehabilitation.