腹腔镜技术在非外伤性小肠穿孔中的应用

Application of laparoscopic technique in non-traumatic intestinal perforation

目的:观察并对比腹腔镜手术与开腹手术治疗非外伤性小肠穿孔的临床效果。方法:回顾性分析2016年2月至2021年12月收治的32例非外伤性小肠穿孔患者的临床资料,其中15例行腹腔镜手术(腹腔镜组),17例行开腹手术(开腹组)。对比分析两组术前及术后相关指标,包括患者性别、年龄、体重指数、手术时间、胃肠功能恢复时间、住院时间及术后肠梗阻、切口感染等并发症发生率。结果:两组患者术前基本资料差异无统计学意义(P>0.05)。与开腹组相比,腹腔镜组术后肛门排气早[(4.5±1.3)d vs.(5.4±0.9)d,P=0.042],腹腔引流时间短[(6.3±1.8)d vs.(8.8±3.1)d,P=0.012],住院时间短[(10.5±2.3)d vs.(16.9±7.9)d,P=0.005],总住院费用少[(2.46±0.88)万元vs.(3.76±1.79)万元,P=0.016]。两组术后并发症发生率差异无统计学意义(P>0.05)。结论:在严格把握腹腔镜手术指征的条件下,腹腔镜手术治疗非外伤性小肠穿孔创伤更小,患者术后康复更快,符合现代微创外科的理念,值得临床应用。

Objective:To observe and compare the clinical effect of laparoscopic surgery and laparotomy in non-traumatic i ntestinal perforation.Methods:Clinical data of 32 patients with non-traumatic intestinal perforation from Feb.2016 to Dec.2021 were retrospectively analyzed.All 32 patients received surgical treatment,including 15 patients in the laparoscopic surgery group and 17 p atients in the open surgery group.The preoperative and postoperative indicators of the two groups were compared and analyzed,including gender,age,body mass index,operation time,gastrointestinal function recovery time,hospital stay,postoperative intestinal obstruction,incision infection and other complications.Results:There was no statistical difference in preoperative basic data between the two groups(P>0.05).Compared with the open surgery group,the laparoscopic surgery group had earlier postoperative anal exhaust time[(4.5±1.3)d vs.(5.4±0.9)d,P=0.042],shorter abdominal drainage time[(6.3±1.8)d vs.(8.8±3.1)d,P=0.012],shorter hospital stay[(10.5±2.3)d vs.(16.9±7.9)d,P=0.005]and less total hospitalization cost[(2.46±0.88)ten thousand yuan vs.(3.76±1.79)ten thousand yuan,P=0.016].There was no significant difference in postoperative complication rate between the two groups(P>0.05).Conclusions:Under the condition of strict grasping the indications of laparoscopic surgery,laparoscopic surgery for non-traumatic intestinal perforation has fewer trauma and faster postoperative recovery,it is in line with the concept of modern minimally invasive surgery and deserves to be recommended in the clinical application.