摘要
目的研究腹腔镜修补术(LR)治疗腹膜内型创伤性膀胱破裂(ITBR)及对创伤后应激障碍(PTSD)相关症状的影响。方法回顾性分析2013年7月—2021年6月成都医学院第一附属医院泌尿外科治疗的64例ITBR患者的临床资料,男性39例,女性25例;年龄22~71岁,平均45.3岁;致伤原因道路交通伤43例,高处坠落伤11例,殴打伤6例,砸伤4例。依照手术方式将64例ITBR患者分为LR组(n=33)与OR组(n=31),LR组行腹腔镜修补治疗,OR组行开腹修补术。观察两组术中出血量、手术时间、术后肠道恢复时间、下地活动时间、术后视觉模拟评分(VAS)、术后住院时间等围术期指标,术后并发症,术前1d及术后1d、3d PTSD相关症状。结果LR组术中出血量(51.07±5.33)mL、手术时间(72.76±9.38)min、术后肠道恢复时间(22.98±2.52)h、下地活动时间(1.07±0.13)d、术后4h VAS(1.09±0.13)分、术后住院时间(4.65±0.51)d均少于OR组(128.78±14.31)mL、(98.87±10.28)min、(28.17±3.04)h、(2.61±0.29)d、(2.87±0.30)分、(8.97±0.92)d,P<0.05。两组术后并发症发病率差异无统计学意义(18%vs.23%,P>0.05)。术后1d,LR组再体验(11.29±1.41)分、回避麻木(15.88±1.91)分、警觉性增高(11.43±1.45)分、总分(38.67±4.21)分,均低于OR组(14.64±1.60)分、(19.82±2.30)分、(15.72±1.67)分、(50.18±5.35)分,P<0.05。术后3d,LR组再体验(7.98±0.85)分、回避麻木(9.97±1.05)分、警觉性增高(8.36±0.87)分、总分(26.22±2.87)分,均低于OR组(10.76±1.24)分、(15.92±1.82)分、(11.07±1.27)分、(37.75±3.97)分,P<0.05。结论LR治疗ITBR创伤小、疼痛程度轻、术后恢复快、术后并发症少,可有效改善患者PTSD相关症状,提高其生活质量。
Objective To study the effect of laparoscopic repair(LR)in treating intraperitoneal traumatic bladder rupture(ITBR)and its symptoms associated with post-traumatic stress disorder(PTSD).Methods A retrospective analysis was performed on the medical data of 64 patients with ITBR who received treatment in our hospital from Jul.2013 to Jun.2021.There were 39 males and 25 females;the age ranged from 22 to 71 years,with an average of 45.3 years;causes of injury:43 cases of road traffic injury,11 cases of falling injury,6 cases of beating injury and 4 cases of smashing injury.They were divided into LR group(n=33)and OR group(n=31)according to operation method,the LR group was given LR,and the OR group was given open repair(OR).Perioperative period indexes such as intraoperative blood loss,operative time,postoperative intestinal recovery time,off-bed time,postoperative pain degree,postoperative hospital stay were observed in the two groups.Postoperative complications,PTSD related symptoms at preoperatively day 1 and postoperative days 1 and 3 were observed in the two groups.Results The intraoperative blood loss was(51.07±5.33)mL,operation time was(72.76±9.38)minutes,postoperative intestinal recovery time was(22.98±2.52)hours,off-bed time was(1.07±0.13)days,postoperative 4h pain was(1.09±0.13)minutes,postoperative hospital stay was(4.65±0.51)days in the LR group,all less than those in OR group[(128.78±14.31)mL,(98.87±10.28)minutes,(28.17±3.04)hours,(2.61±0.29)days,(2.87±0.30)minutes,(8.97±0.92)days,P<0.05].There was no difference in the incidence of postoperative complications between the two groups(18%vs.23%,P>0.05).At postoperative day 1,recapture score was(11.29±1.41)points,avoidance numbness was(15.88±1.91)points,increased alertness was(11.43±1.45)points,and the total score was(38.67±4.21)points in the LR group,which were lower than those in the OR group[(14.64±1.60)points,(19.82±2.30)points,(15.72±1.67)points,(50.18±5.35)points,P<0.05].At postoperative day 3,recapture was(7.98±0.85)points,avoidance numbness was(9.97±1.05)points,increased alertness was(8.36±0.87)points,and the total score was(26.22±2.87)points,all lower than those in the OR group[(10.76±1.24)points,(15.92±1.82)points,(11.07±1.27)points and(37.75±3.97)points,P<0.05].Conclusion LR for the treatment of ITBR has little trauma,slight pain,quick postoperative recovery and few postoperative complications,which can effectively improve symptoms associated with PTSD and improve the quality of life of patients.
作者
赵涛
王英
杨雷
刘佳
王霞
Zhao Tao;Wang Ying;Yang Lei;Liu Jia;Wang Xia(Department of Urology,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China;Department of Vascular Surgery,Mianyang Central Hospital,Mianyang,Sichuan 621000,China;Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment,Chongqing University Cancer Hospital&Chongqing Cancer Institute&Chongqing Cancer Hospital,Chongqing 400030,China)
出处
《创伤外科杂志》
2022年第4期304-308,共5页
Journal of Traumatic Surgery
关键词
创伤性膀胱破裂
腹腔镜修补术
创伤后应激障碍
traumatic bladder rupture
laparoscopic repair
post-traumatic stress disorder