腹腔镜治疗粘连性肠梗阻经验总结

发布时间：2019-03-22 19:06

【摘要】：目的:探讨腹腔镜治疗粘连性肠梗阻的可行性、安全性及治疗经验。方法:回顾我院2010年1月～2016年12月的15例腹腔镜下粘连性肠梗阻手术病例。此15例患者分别非随机行急诊手术(肠梗阻急性发作期)及择期手术(肠梗阻缓解期)。对患者基础情况、术后炎症指标、肛门排气时间、术后住院时间及并发症分别进行分析,展示手术方式总结治疗经验。结果:入组的15例患者男、女分别有12例和3例,平均年龄为51.87±17.20岁,既往有手术史患者13例,ASA1级、2级均为6例患者,平均手术时间2.47±1.48小时,平均出血量22.33±28.09ml,平均肛门排气时间为术后3.13±1.55天,平均进食时间为术后5.00±2.04天,切口疼痛1级患者为11例,疼痛2级、3级患者均为1例,疼痛4级患者2例,15例手术病人中共有5例出现发热超过3天,平均术后发热时间2.07±1.53天,平均术后1天CRP为34.08±33.63 mg/L,平均术后3天CRP 为 48.31±38.25mg/L,平均术后 1 天 WBC 为 8.34±3.14*109/L,平均术后 3 天WBC为7.53±4.13*109/L,平均术后住院时间为8.93±5.85天。择期手术治疗的8例患者,其中3例行小肠部分切除;急诊下直接手术7例,其中2例行小肠部分切除,1例中转开放。结论:在梗阻缓解期采用腹腔镜治疗粘连性肠梗阻更具有安全性;急性梗阻期腹腔镜治疗粘连性肠梗阻应谨慎开展。
[Abstract]:Objective: to explore the feasibility, safety and experience of laparoscopic treatment of adhesive intestinal obstruction. Methods: 15 cases of laparoscopic adhesive intestinal obstruction from January 2010 to December 2016 in our hospital were retrospectively reviewed. These 15 patients underwent emergency operation (acute attack of intestinal obstruction) and selective operation (remission stage of intestinal obstruction) respectively. The patients' basic condition, postoperative inflammation index, anal exhaust time, postoperative hospitalization time and complications were analyzed, and the experience of surgical treatment was summarized. Results: there were 12 males and 3 females in the group, the average age was 51.87 卤17.20 years. There were 13 patients with previous operation history, 6 patients with ASA1 grade and 6 patients with grade 2, the average operation time was 2.47 卤1.48 hours. The average bleeding volume was 22.33 卤28.09 ml, the mean anal exhaust time was 3.13 卤1.55 days after operation, the average feeding time was 5.00 卤2.04 days after operation, 11 patients with grade 1 incision pain, 1 patient with grade 2 pain, 1 patient with grade 3 pain, 1 patient with grade 1 pain, 1 patient with grade 3 pain. The average postoperative fever time was 2.07 卤1.53 days, and the mean postoperative CRP was 34.08 卤33.63 mg/L,. The mean postoperative CRP was 48.31 卤38.25mg / L on the 3rd day after operation, and the mean postoperative febrile time was 2.07 卤1.53mg / L, and the mean postoperative Fever was 34.08 卤33.63mg / L on the first day after operation. The mean postoperative WBC was 8.34 卤3.14 脳 109 / L, the mean WBC was 7.53 卤4.13 卤109 / L on the 3rd day after operation, and the average hospitalization time was 8.93 卤5.85 days. Of the 8 patients who underwent selective surgery, 3 underwent partial small bowel resection, and 7 underwent emergency direct surgery, of which 2 underwent partial small bowel resection and 1 was converted to open. Conclusion: laparoscopic treatment of adhesive intestinal obstruction in the remission stage of obstruction is more safe, and laparoscopic treatment of adhesive intestinal obstruction in acute obstructive stage should be carried out with caution.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.7

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