腹腔镜下粘连松解术对粘连性肠梗阻的临床应用效果观察

Clinical application of laparoscopic lysis of adhesions in adhesive intestinal obstruction

摘要:

目的 探讨腹腔镜肠粘连松解术治疗粘连性肠梗阻的临床疗效和安全性。方法 回顾性分析95 例手术治疗的粘连性肠梗阻患者的临床资料和随访资料，依手术方式将患者分为开腹组（43 例）和腔镜组（52 例），比较两组患者术中情况、术后并发症及复发情况。结果 腔镜组的手术时间小于开腹组[（68.35±36.47） vs（82.54±23.27）min，t =2.21，P =0.029] ；术中出血量少于开腹组[（69.51±20.33）vs（198.37±50.04）ml， t =16.97，P =0.000] ；术后镇痛剂使用量少于开腹组[（1.01±0.99）vs（3.46±1.53）支，t =9.41，P =0.000] ；腔 镜组术后离床活动时间短于开腹组[（11.05±1.32）vs（20.36±2.59）d，t =16.97，P =0.000] ；胃肠功能恢复时 间低于开腹组[（2.30±1.38）vs（4.05±1.74）d，t =5.47，P =0.000]；导尿管拔除时间低于开腹组[（3.04±2.11） vs（5.36±2.24）d，t =5.19，P =0.000] ；住院天数低于开腹组[（5.89±1.57）vs（10.36±2.65）d，t =10.02， P =0.000] ；腔镜组和开腹组患者术后并发症发生率分别为3.84%（2 例）和16.27%（7 例），差异无统计学意义 （χ2=4.24，P =0.074）；随访观察8 ～ 36 个月，腔镜组和开腹组分别有2 和6 例出现顽固性腹痛和粘连性肠梗 阻复发，开腹组复发结局事件的累计函数高于腔镜组，但差异无统计学意义（χ2=3.64，P =0.056）。结论 腹 腔镜粘连松解术治疗粘连性肠梗阻安全、有效，具有创伤小，对腹腔干扰少的特征，效果优于开腹手术。

Abstract:

Objective To evaluate the clinical efficacy and safety of laparoscopic adhesiolysis for patients with adhesive ileus. Methods Clinical data and follow-up data of 95 cases of adhesive ileus were retrospectively analyzed. Based on the surgical approach, patients were divided into laparotomy group (43 cases) and laparoscopic group (52 cases), and the intraoperative situation postoperative complications and recurrence were compared. Results The operation time of laparoscopy group was less than the laparotomy group [(68.35 ± 36.47) vs (82.54 ± 23.27) min, t = 2.21, P = 0.029]; blood loss was less than the laparotomy group [(69.51 ± 20.33) vs (198.37 ± 50.04) ml, t = 16.97, P = 0.000]; postoperative analgesic dosage was less than the laparotomy group [(1.01 ± 0.99) vs (3.46 ± 1.53), t = 9.41, P = 0.000]; time of posterior ambulation was less than the laparotomy group [(11.05 ± 1.32) vs (20.36 ± 2.59) d, t = 16.97, P = 0.000]; gastrointestinal function recovery time was less than laparotomy group [(2.30 ± 1.38) vs (4.05 ± 1.74) d, t = 5.47, P = 0.000]; catheter removal time was lower than the laparotomy group [(3.04 ± 2.11) vs (5.36 ± 2.24) d, t = 5.19, P = 0.000]; hospital stay was less than the laparotomy group [(5.89 ± 1.57) vs (10.36 ± 2.65) d, t = 10.02, P = 0.000]; the postoperative complication rate of laparoscopy group and laparotomy group was 3.84% (2 cases) and 16.27% (7 cases), respectively, the difference was not statistically significance (χ2 = 4.24, P = 0.074); followed up from 8 to 36 months, there were 2 cases, 6 cases of intractable abdominal pain and intestinal obstruction recurrence in laparoscopy group and laparotomy group respectively, the relapse outcomes of laparotomy group was higher than laparoscopy group, but the difference was not statistically significant (χ2 = 3.64, P = 0.056). Conclusion Laparoscopic adhesiolysis is safe, effective, and have the characteristics with less trauma, less interference on the abdominal cavity, it is better than open surgery.