无腹部手术史腹内疝的临床特点及腹腔镜应用评估

Clinical characteristics and laparoscopic application evaluation of internal abdominal hernia without abdominal operation history

目的研究无腹部手术史的腹内疝所导致肠梗阻的临床表现特点及手术处理方法,及腹腔镜探查在该类疾病诊断和治疗方面有无优势。方法回顾性分析2006年3月至2020年3月,北京市垂杨柳医院收治无腹部手术史腹内疝患者20临床表现,早期10例行开腹手术,后期10例行腹腔镜下诊断和治疗,并进行对比分析。结果该病的特点是绝大部分以肠梗阻为主要临床表现,但腹胀往往较轻,或较晚出现,而肠绞窄、肠坏死出现相对较早。CT检查术前确诊率不高,对临床医师的早期诊断与及时手术治疗提出考验。术前5例经CT确诊,其余15例均经手术中探查证实。其中,肠切除吻合6例,手术复位14例。术后1例死亡,其余患者均痊愈出院。腹腔镜组在手术时间、术中出血量、术后排气时间、下床活动时间、住院时间及术后并发症上与对照组比较,差异有统计学意义(P<0.05)。结论无腹部手术史的腹内疝所导致肠梗阻缺乏特异性临床表现,提高临床外科医师对本病的认识,早期行腹腔探查术是提高治疗效果,挽救患者生命的关键;腹腔镜在此类疾病中的应用安全有效,可以明确诊断,经全腹腔镜或腹腔镜辅助下完成手术可最大限度的达到微创的目的。

Objective To investigate the clinical features and surgical management of intestinal obstruction caused by internal hernia without history of abdominal surgery,and whether laparoscopic exploration has advantages in the diagnosis and treatment of this disease.Methods The clinical features of 20 cases of internal abdominal hernia without abdominal operation history in Beijing Chuiyangliu hospital were retrospectively analyzed.10 cases were diagnosed and treated bylaparotomy in the early stage and 10 cases by laparoscopy in the later stage.A comparative analysis was conducted between the two groups.Results This disease was characterized by the majority of intestinal obstruction as the main clinical manifestations,but abdominal distension was often light or late,whereas intestinal strangulation and necrosis appeared relatively early.This disease progressed dangerously,and the preoperative diagnosis rate of CT examination was not high,which put forward the test for the early diagnosis and timely surgical treatment of clinicians.Preoperative 5 cases were confirmed by CT,and the remaining 15 cases were confirmed by intraoperative exploration.Among them,6 cases underwent intestinal resection and anastomosis,and 14 cases underwent surgical reduction.One patient died after the operation,and all the other patients recovered.There were statistically significant differences between the laparoscopic group and the control group in terms of the operation time,intraoperative blood loss,postoperative exhaust time,out-of-bed activity time,hospital stay time and postoperative complications.Conclusion There is no specific clinical manifestation of intestinal obstruction due to internal hernia with no history of abdominal surgery.To improve clinical surgeons’understanding of this disease,early abdominal exploration is the key to improve the curative effect and save the patients’lives.The application of laparoscope in this kind of disease is safe and effective,can make clear diagnosis.Minimally invasive surgery can be accomplished with full laparoscopy or laparoscopic-assisted surgery.