腹腔镜胃肠修补术联合腹部外加压治疗腹部闭合性损伤疗效

Effect of laparoscopic gastrointestinal repair combined with abdominal pressure on abdominal closed injury

目的 探讨腹腔镜胃肠修补术联合腹部外加压治疗腹部闭合性损伤的临床疗效,观察其对术后疼痛和胃肠功能的影响。方法 选取自2019年3月至2021年3月收治的120例腹部闭合性损伤患者为研究对象,采用随机数字表法分为A组(n=60)与B组(n=60)。A组患者行腹腔镜胃肠修补术后给予无负压自然引流,并于切口处覆盖医用辅料,给予常规换药。B组患者行腹腔镜胃肠修补术后加用气囊加压腹带持续负压引流,并于切口处覆盖负压封闭引流技术辅料。记录并比较两组患者住院时间、术后引流量、术后排气时间、术后排便时间、术后进食时间、肠鸣音恢复时间、术前及术后7 d的胃肠激素[胃动素(MOT)、血管活性肠肽(VIP)、胃泌素(GAS)]水平及不良反应发生情况。分别于苏醒时及术后2、12、24、48 h评估两组患者视觉模拟评分(VAS),比较两组患者术后疼痛情况。结果 B组住院时间短于A组,术后引流量少于A组,差异有统计学意义(P<0.05)。苏醒时及术后2、12、24、48 h,B组VAS评分均低于A组,差异有统计学意义(P<0.05)。B组患者术后排气时间、术后排便时间、术后进食时间及肠鸣音恢复时间均短于A组,差异有统计学意义(P<0.05)。术前,两组患者MOT、VIP、GAS比较,差异无统计学意义(P>0.05)。术后7 d,两组患者MOT、VIP、GAS均较术前下降,但B组高于A组,差异有统计学意义(P <0.05)。A组患者发生术后切口感染1例,不良反应发生率为1.7%(1/60);B组患者发生切口感染2例、肠粘连1例,不良反应发生率为5.0%(3/60)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 腹腔镜胃肠修补术联合腹部外加压治疗腹部闭合性损伤具有较好的临床疗效,可显著降低患者疼痛,改善胃肠功能,安全性高。

Objective To investigate the effect of laparoscopic gastroenteroplasty combined with abdominal pressure in the treatment of closed abdominal injury and its effects on postoperative pain and gastrointestinal function.Methods A total of 120 patients with abdominal closed injury admitted from March 2019 to March 2021 were selected and randomly divided into group A(n=60)and group B(n=60).The patients in the group A were treated with laparoscopic gastroenteroplasty and natural drainage without negative pressure,and then covered with medical excipients at the incision.The group B received continuous negative pressure drainage after laparoscopic gastroenteroplasty,and covered with vacuum sealing drainage excipients at the incision.The time of hospital stay,postoperative drainage volume,postoperative exhaust time,postoperative defecation time,postoperative eating time,bowel sound recovery time,the levels of gastrointestinal hormones[motillin(MOT),vasoactive intestinal peptide(VIP),gastrin(GAS)]before and 7 days after the operation and the occurrence of adverse reactions were recorded and compared between the two groups.Visual analogue scale(VAS)was evaluated at the time of recovery and 2,12,24 and 48 hours after the surgery respectively,and the postoperative pain of the two groups was compared.Results The time of hospital stay of group B was shorter than that of group A,and the postoperative drainage volume was lower than that of group A,the differences were statistically significant(P<0.05).The VAS scores of group B were lower than those of group A at the time of recovery and 2,12,24 and 48 hours after the surgery,and the differences were statistically significant(P<0.05).Postoperative exhaust time,postoperative defecation time,postoperative eating time and intestinal sound recovery time in group B were shorter than those in group A,and the differences were statistically significant(P<0.05).Before the surgery,there was no significant difference in MOT,VIP and GAS between the two groups(P>0.05).Seven days after the surgery,MOT,VIP and GAS in the two groups were decreased,but MOT,VIP,GAS of group B were higher than those of group A,the differences were statistically significant(P<0.05).One patient in group A occurred incision infection,and the incidence of adverse reactions was 1.7%(1/60).Two patients in group B occurred incision infection and one patient in group B occurred intestinal adhesion,and the incidence of adverse reactions was 5.0%(3/60).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Laparoscopic gastrointestinal repair combined with external abdominal pressure in the treatment of closed abdominal injury has a good clinical effect.It can significantly reduce the pain of patients,improve gastrointestinal function,with high safety.