腹腔镜探查在成人小肠异物穿孔中的应用价值

Application value of laparoscopic exploration in adult small intestinal foreign body perforation

目的探讨腹腔镜探查在成人小肠异物穿孔中的应用价值。方法选取2005年1月至2021年12月收治的57例成人小肠异物穿孔患者为研究对象,根据探查方法不同将其分为开腹组(24例),腹腔镜组(21例),中转开腹组(12例)。开腹组给予开腹探查及手术,腹腔镜组给予腹腔镜探查及手术,中转开腹组由腹腔镜探查及手术转为开腹探查及手术。比较三组的治疗效果。结果中转开腹组的小肠部分切除占比高于腹腔镜组,差异具有统计学意义(P<0.05);腹腔镜组的手术时间短于中转开腹组及开腹组,术中出血量少于中转开腹组及开腹组,差异具有统计学意义(P<0.05);中转开腹组和开腹组的手术时间、术中出血量比较,差异无统计学意义(P>0.05)。腹腔镜组的炎性指标恢复时间、下床时间、排气时间、拔管时间及住院时间短于中转开腹组及开腹组,差异具有统计学意义(P<0.05);中转开腹组和开腹组的炎性指标恢复时间、下床时间、排气时间、拔管时间及住院时间比较,差异无统计学意义(P>0.05)。腹腔镜组的并发症总发生率低于中转开腹组及开腹组(P<0.05)。结论腹腔镜探查在成人小肠异物穿孔中的应用效果较好,其可缩短手术时间,减少术中出血量,加快术后恢复,降低并发症发生率,值得临床应用。

Objective To explore the application value of laparoscopic exploration in adult small intestinal foreign body perforation.Methods A total of 57 adult patients with small intestinal foreign body perforation admitted from January 2005 to December 2021 were selected as the research objects.According to different exploration methods,the patients were divided into laparotomy group(24 cases),laparoscopy group(21 cases)and conversion to laparotomy group(12 cases).The laparotomy group was given open exploration and surgery,the laparoscopy group was given laparoscopic exploration and surgery,and the conversion to laparotomy group was changed from laparoscopic exploration and surgery to open exploration and surgery.The therapeutic effects of the three groups were compared.Results The proportion of partial small bowel resection in the conversion to laparotomy group was higher than that in the laparoscopy group,and the difference was statistically significant(P<0.05);the operation time of the laparoscopy group was shorter than that of the conversion to laparotomy group and the laparotomy group,and the intraoperative blood loss was less than that of the conversion to laparotomy group and the laparotomy group,the differences were statistically significant(P<0.05);there were no significant differences in operation time and intraoperative blood loss between the conversion to laparotomy group and the laparotomy group(P>0.05).The recovery time of inflammatory indexes,time of getting out of bed,exhaust time,extubation time and hospitalization time in the laparoscopy group were shorter than those in the conversion to laparotomy group and the laparotomy group,and the differences were statistically significant(P<0.05);there were no significant differences in the recovery time of inflammatory indexes,the time of getting out of bed,exhaust time,extubation time and hospitalization time between the conversion to laparotomy group and the laparotomy group(P>0.05).The total incidence of complications in the laparoscopy group was lower than that in the conversion to laparotomy group and the laparotomy group(P<0.05).Conclusion Laparoscopic exploration has a good application effect in adult small intestinal foreign body perforation,which can shorten the operation time,reduce the amount of intraoperative blood loss,accelerate postoperative recovery,and reduce the incidence of complications,it is worthy of clinical application.