CAJ | 학술논문

目的：探讨机械性小肠梗阻的腹腔镜最佳手术时机。方法2010年1月-2011年12月收治的130例机械性小肠梗阻的治疗及效果。其中，早期施行腹腔镜手术（ELS）患者58例，延期手术（PS）患者32例及保守治疗（ET）患者40例。比较不同治疗方案患者的疗效。结果ELS组共计58例，无中转开腹病例，所有患者术后无严重并发症；PS组32例，治愈32例，16例出现不同程度的术后并发症；ET组40例，治疗后梗阻复发25例。ELS在手术时间、术中出血、术后恢复、住院费用及预后方面均优于PS组（P<0.05），ET组复发率最高（P<0.05），组间差异有统计学意义。结论在技术和设备完善的前提下，早期腹腔镜手术在机械性小肠梗阻的诊断、治疗及预后等方面优于传统的保守治疗及开腹手术。对于高度怀疑是机械性肠梗阻的，可尽快行腹腔镜探查明确诊断；机械性小肠梗阻一经诊断，建议行腹腔镜手术治疗。
목적：탐토궤계성소장경조적복강경최가수술시궤。방법2010년1월-2011년12월수치적130례궤계성소장경조적치료급효과。기중，조기시행복강경수술（ELS）환자58례，연기수술（PS）환자32례급보수치료（ET）환자40례。비교불동치료방안환자적료효。결과ELS조공계58례，무중전개복병례，소유환자술후무엄중병발증；PS조32례，치유32례，16례출현불동정도적술후병발증；ET조40례，치료후경조복발25례。ELS재수술시간、술중출혈、술후회복、주원비용급예후방면균우우PS조（P<0.05），ET조복발솔최고（P<0.05），조간차이유통계학의의。결론재기술화설비완선적전제하，조기복강경수술재궤계성소장경조적진단、치료급예후등방면우우전통적보수치료급개복수술。대우고도부의시궤계성장경조적，가진쾌행복강경탐사명학진단；궤계성소장경조일경진단，건의행복강경수술치료。
Objective To investigate the time window of laparoscopic surgery of mechanical small intestinal obstruction. Methods Clinical data of 130 cases with mechanical small intestinal obstruction of the hospital from January 2010 to December 2011 were analyzed, which including 58 cases treated with early laparoscopic surgery (group ELS),32 cases of postpone surgery (group PS) and 40 cases of expectant treatment(group ET). The investigation devises a treatment effectiveness evaluation among 3 groups. Results All 58 cases of group ELS were cured without converting to open laparotomy and serious postoperative complications. 16 of 32 cases of group PS appeared varying degrees of postoperative complications. 25 cases of 40 patients in group ET had obstruction relapsed. The study showed that group ELS are superior to group PS in operation time, intraoperative blood loss, postoperative recovery, hospitalization expense and prognosis(P<0.05), while group ET had a highest relapse rate(P<0.05). There are significant differences among 3 groups. Conclusion Early laparoscopic surgery has more advantages in early diagnosis, treatment effect and prognosis than postpone surgery and expectant treatment of mechanical small intestinal obstruction under the precondition of technical skills and better facilities. A laparoscopy exploration must be essential for that highly suspected to make a definitive diagnosis. Once the diagnosis is made, operation should be preformed and suggested.