腹部创伤患者开腹与腔镜治疗的临床疗效比较

Clinical effectiveness comparison of laparotomy and laparoscopy in patients with abdominal trauma

目的:通过与传统开腹手术的临床疗效对比,评估腹腔镜技术应用于腹部创伤的临床价值。方法:回顾性分析我院急救创伤中心近9年收治的腹部创伤患者病例资料。用1∶1倾向得分匹配方法为腔镜病例选择最合适的开腹对照病例。将匹配后的病例作为研究对象,根据其手术方式分别纳入开腹组和腔镜组,分析对比两组间入院时心率和血压、受伤后院前时间、院内术前时间、手术时间、术中出血量、术后ICU时间、术后呼吸机时间、术后首次肛门排气时间、术后引流时间、总住院天数、总住院费用、并发症发生率、非计划性二次手术率等临床指标的差异。结果:共纳入222例患者作为研究对象,其中开腹组和腔镜组各111例(各占50%);最常见的致伤因素为交通事故伤,共75例(34%);最常见的受累脏器为小肠,共55例(25%)。腔镜组总住院时间明显短于开腹组(14 d vs.18 d,P=0.000);术中出血量较开腹组明显减少(200 mL vs.400 mL,P=0.000);术后首次肛门排气时间短于开腹组[(3.54±2.52)d vs.(4.63±2.98)d,P=0.004]。但平均手术时间长于开腹组[(3.51±1.56)h vs.(3.08±1.46)h,P=0.030];总住院费用亦高于开腹组(74128.00元vs.47911.40元,P=0.004)。结论:腹腔镜是一种有效的诊断工具,同时也是一种安全的微创治疗手段。其应用于腹部创伤的治疗能减少术中出血,避免不必要的开腹探查,有效缩短住院时间,从而降低腹部创伤患者术后并发症发生率和病死率。

Objective:To evaluate the clinical value of laparoscopy in abdominal trauma by comparing with traditional open surgery.Method:The data of patients who underwent laparotomy or laparoscopic exploration in the Emergency Trauma Center of Southwest Hospital in recent nine years was analyzed retrospectively.Depending on the mode of operation,the patients were divided into laparotomy group and laparoscopic surgery group.The clinical indexes such as heart rate and blood pressure at admission,pre-hospital time,preoperative time,operation time,intraoperative blood loss,postoperative ICU stay,postoperative ventilator time,postoperative first anal exhaust time,postoperative drainage time,total hospital stay,total hospitalization costs,incidence of complications and unplanned secondary operation were analyzed and compared.Result:A total of 222 patients were included in the study.111(50%)patients were in the laparotomy group and 111(50%)patients in the endoscopy group.The most common injury factor was traffic accident injury(75 cases,34%).The most common involved organ was the small intestine(55 cases,25%).The total hospital stay in the laparoscopy group was significantly shorter than that in the laparotomy group(14 d vs.18 d,P=0.000).The intraoperative blood loss was significantly reduced compared with the open group(200 mL vs.400 mL,P=0.000).The first anal exhaust time after operation was shorter than that of the laparotomy group(3.54±2.52 d vs.4.63±2.98 d,P=0.004).However,the average operation time was longer than that in the open group(3.51±1.56 h vs.3.08±1.46 h,P=0.030),and the total hospitalization cost was also higher than that in the open group(74128.00 vs.47911.40,P=0.004).Conclusion:Laparoscopy is an effective diagnostic tool and a safe minimally invasive treatment.Its application in the treatment of abdominal trauma notably reduces intraoperative bleeding,avoids unnecessary exploratory laparotomy,and effectively shortens the duration of hospitalization.Thus,the application of laparoscopy reduces the incidence of postoperative complications and mortality in patients with abdominal trauma.