中国现代医生
中國現代醫生
중국현대의생
CHINA MODERN DOCTOR
2010年
23期
23-25,30
,共4页
肠梗阻%腹腔镜%诊治价值
腸梗阻%腹腔鏡%診治價值
장경조%복강경%진치개치
Intestinal obstruction (bowel obstruction)%Laparoscopy%Value of diagnosis and treatment
目的 探讨腹腔镜技术诊治肠梗阻的价值.方法 对我院2006年2月～2009年2月入院且应用腹腔镜进行诊治的46例肠梗阻病例的临床资料进行回顾性分析.术前明确诊断的为:粘连性肠梗阻36例,肠扭转1例,肿瘤3例,未明确诊断6例.结果 诊断:未明确诊断的6例在腹腔镜下得以确诊.治疗:32例粘连性肠梗阻病例在镜下成功进行了单纯粘连松解术;3例用超声刀切下所粘连的腹膜而解除梗阻;2例小肠与小肠粘连者,则须经扩大的穿刺口将病变的肠段拉出腹壁外,手工分离粘连和作肠壁修补术;1例粘连复杂,须中转开腹完成手术;2例疑有肠段坏死的,也通过扩大腹部穿刺口将病变的肠段拉出腹壁外,手工加以切除和吻合;2例乙状结肠扭转而造成的肠梗阻,通过用肠钳等器械翻动梗阻的肠段,从而解除梗阻;1例乙状结肠扭转而造成的梗阻肠段坏死,须经中转开腹作肠切除术及暂时性结肠造瘘术,3周后再作结肠吻合术;3例结肠肿瘤所致的梗阻在腹腔镜辅助下进行了根治术.随访45例,一年内发生肠梗阻的为3例,发生率为6.7%.结论 应用腹腔镜对肠梗阻的诊断具有确诊率高,尤其是对一些难以明确病因的更有重要的临床价值.在治疗上也有很大的优势,能在相对密封的状态下完成手术,因而术后的肠粘连得以明显减少.
目的 探討腹腔鏡技術診治腸梗阻的價值.方法 對我院2006年2月～2009年2月入院且應用腹腔鏡進行診治的46例腸梗阻病例的臨床資料進行迴顧性分析.術前明確診斷的為:粘連性腸梗阻36例,腸扭轉1例,腫瘤3例,未明確診斷6例.結果 診斷:未明確診斷的6例在腹腔鏡下得以確診.治療:32例粘連性腸梗阻病例在鏡下成功進行瞭單純粘連鬆解術;3例用超聲刀切下所粘連的腹膜而解除梗阻;2例小腸與小腸粘連者,則鬚經擴大的穿刺口將病變的腸段拉齣腹壁外,手工分離粘連和作腸壁脩補術;1例粘連複雜,鬚中轉開腹完成手術;2例疑有腸段壞死的,也通過擴大腹部穿刺口將病變的腸段拉齣腹壁外,手工加以切除和吻閤;2例乙狀結腸扭轉而造成的腸梗阻,通過用腸鉗等器械翻動梗阻的腸段,從而解除梗阻;1例乙狀結腸扭轉而造成的梗阻腸段壞死,鬚經中轉開腹作腸切除術及暫時性結腸造瘺術,3週後再作結腸吻閤術;3例結腸腫瘤所緻的梗阻在腹腔鏡輔助下進行瞭根治術.隨訪45例,一年內髮生腸梗阻的為3例,髮生率為6.7%.結論 應用腹腔鏡對腸梗阻的診斷具有確診率高,尤其是對一些難以明確病因的更有重要的臨床價值.在治療上也有很大的優勢,能在相對密封的狀態下完成手術,因而術後的腸粘連得以明顯減少.
목적 탐토복강경기술진치장경조적개치.방법 대아원2006년2월～2009년2월입원차응용복강경진행진치적46례장경조병례적림상자료진행회고성분석.술전명학진단적위:점련성장경조36례,장뉴전1례,종류3례,미명학진단6례.결과 진단:미명학진단적6례재복강경하득이학진.치료:32례점련성장경조병례재경하성공진행료단순점련송해술;3례용초성도절하소점련적복막이해제경조;2례소장여소장점련자,칙수경확대적천자구장병변적장단랍출복벽외,수공분리점련화작장벽수보술;1례점련복잡,수중전개복완성수술;2례의유장단배사적,야통과확대복부천자구장병변적장단랍출복벽외,수공가이절제화문합;2례을상결장뉴전이조성적장경조,통과용장겸등기계번동경조적장단,종이해제경조;1례을상결장뉴전이조성적경조장단배사,수경중전개복작장절제술급잠시성결장조루술,3주후재작결장문합술;3례결장종류소치적경조재복강경보조하진행료근치술.수방45례,일년내발생장경조적위3례,발생솔위6.7%.결론 응용복강경대장경조적진단구유학진솔고,우기시대일사난이명학병인적경유중요적림상개치.재치료상야유흔대적우세,능재상대밀봉적상태하완성수술,인이술후적장점련득이명현감소.
Objective To investigate the value of laparoscopic diagnosis and treatment for intestinal obstruction. Methods Retrospective analysis to the clinical data of 46 cases of intestinal obstruction admitted to hospital from February 2006 to February 2009 with the application of laparoscopy. Preoperative diagnosis declared: 36 cases of adhesive intestinal obstruction, 1 case of volvulus, 3 cases of tumor, 6 eases of unconfirmed diagnosis. Results Diagnosis: 6 cases of unconfirmed diagnosis were confirmed with the help of laparoscopy. Treatment: single adhesiolysis for 32 cases of adhesive obstruction were successfully carried out under laparoscopy. 3 cases released from adhesive obstruction by cutting of the peritoneal adhesions with ultrasonic-harmonic scalpel. For 2 cases whose adhesive band lain between intestines, the separation of adhesions and the repair of intestinal wall were carried out manually from the extended puncture wound. 1 case of complex adhesion needed to conversion to laparotomy. For 2 cases of suspected intestines necrosis, the segments which are pathological deteriorated were pulled out through the extended puncture wound, cut of and created anastomosis. 2 cases of intestinal obstruction caused by sigmoid volvulus were released by the way of using instruments such as intestinal clamp to turn the obstructed intestines into normality. 1 case of necrosis of obstructed intestine caused by sigmoid volvulus was conversed to laparotomy to get rid of the necrosis part and temporary colostomy. Colonic anastomosis was carried out 3weeks later. 3 cases of obstruction caused by colon cancer undergone radical operation in the way of laparoscopic-assisted. In the follow-up of 45 cases, 3 cases recurred, which rate is 6.7%. Conclusion Application of laparoscopy to the diagnosis of intestinal obstruction is of high confirmed diagnosis rate, especially of important clinical value for some cases of unclear pathogeny. There is also an advantage for the treatment.Operation is performed in a relatively enclosed space, therefore the postoperative intestinal adhesion recurrence can be significantly reduced.
