腹腔镜技术治疗65例粘连性肠梗阻的临床疗效分析

Effect of laparoscopy in treating adhesive intestinal obstruction: an analysis of 65 cases

目的探讨腹腔镜技术治疗粘连性肠梗阻的临床效果。方法回顾性分析郴州市第一人民医院于2013年5月至2017年5月收治的65例粘连性肠梗阻患者的临床资料,分析粘连类型、手术时间、术中出血量、肠管损伤率、中转开腹率及术后并发症发生率、术后平均住院时间及术后梗阻再发率。结果65例患者均在腹腔镜下顺利完成肠粘连松解术,其中1例行肠粘连松解后因肠壁破损较大、再中转开腹取小切口完成肠切除+肠吻合手术。全组平均手术时间为(41.52±10.68)min,术中平均出血量为(18.40±8.50)mL,肠管损伤率达30.76%(20/65),中转开腹率仅为1.54%(1/65),术后平均住院时间(4.50±1.85)d。术后出现并发症者2例,积极治疗后均痊愈出院。随访发现本组患者梗阻再发率为4.61%(3/65)。结论利用腹腔镜技术进行肠粘连松解术治疗粘连性肠梗阻安全可行、疗效确切。

Objectives To investigate the effect of laparoscopy in treating adhesive intestinal obstruction. Methods This was a retrospective analysis of 65 patients with adhesive intestinal obstruction treated in Chenzhou NO.1 People’s Hospital between May 2013 and May 2017. The followings were analyzed: type of adhesion, duration of surgery, blood loss, rate of bowel injury, conversion to open surgery, incidence of postoperative complications, length of hospitalization and incidence of recurrence. Re- sults Laparoscopic lysis of adhesion was completed in all 65 patients. One patient was converted to open surgery after large in testinal wall injury, followed by small incision, intestinal resection and anastomosis. The average duration of surgery was (41.52± 10.68) min, the average amount of intraoperative blood loss was (18.4±8.5) mL, the rate of bowel injury was 30.76%(20/65), the rate of conversion was 1.54%(1/65), the average length of hospitalization was (4.50±1.85) days. Two patients had postoperative complications but fully recoveredafter treatment. The incidence of recurrence during follow-up was 4.61%(3/65). Conclusion Laparoscopic lysis of adhesion is safe and effective for patients with adhesive intestinal obstruction.