经腹腔镜治疗创伤性小肠破裂的初步探索

摘要

目的 初步探讨腹腔镜在治疗创伤性小肠破裂的优势及应用价值.方法 选定我院2010年7月至2012年7月间创伤性小肠破裂患者25例.根据术前腹部CT、彩色多普勒超声检查明确诊断并确定适应证,以腹腔肠系膜水肿、小肠间可见明显游离气体影及超声多普勒超声评估腹腔游离液体≤400 ml的病例作为腹腔镜组(8例),并选择同期开腹手术病例作为传统开腹组(17例).观察并比较2组患者手术时间、首次排气时间及切口感染率等指标.结果 腹腔镜组患者治疗后首次排气时间明显少于传统开腹组[(2.00 ±0.26)d比(2.94±0.18)d,P＜0.01].腹腔镜组和传统开腹组患者手术时间分别为(133.1±3.0)、(131.8±1.9)min,组间差异无统计学意义(P＞0.05).腹腔镜组患者手术切口感染率明显少于传统开腹组[0比47.1％ (8/17),P＜0.05].结论 在术前正确诊断的前提下,采用腹腔镜治疗创伤性小肠破裂方法可行.%Objective To explore the application of laparoscopic treatment of traumatic intestinal rupture.Methods All 25 patients suffered from traumatic intestinal ruputure were selected.Diagnosis was performed using abdominal CT and color Doppler; the operation indication criteria included edema of celiaco-mesenteric,visible free gas shadow in the interspace of small intestine,free liquid with volume less than 400 ml in the abdominal cavity before operation.Eight patients in the operation were treated using laparoscopic skill which met the indication criteria and 17 control patients were treated using the ordinary operations which needed the incision of the abdomen.The operation time,the first fart time and the infection rate caused by the operation were observed and compared between two groups.Results The first fart time in laparoscopic group was shorten than that of open operation group [(2.00±0.26)d vs (2.94 ± 0.18)d,P ＜ 0.01].No infection caused by the operation in laparoscopic group were observed,however,in open operation group,8 cases (47.1％) had infections after the operation (P ＜ 0.05).Also,no difference of operation time were observed between laparoscopy group and open operation group [(133.1 ±3.0) min vs (131.8 ± 1.9) min,P ＞ 0.05].Conclusion Based upon right diagnosis,the laparoscopy is a feasible method in treating the traumatic intestinal rupture.