腹腔镜下急性粪石性小肠梗阻切开取石26例分析

doi:10.3877/cma.j.issn.1674-3946.2022.03.031

目的

探讨腹腔镜下小肠切开取石联合术中小肠阻断在治疗急性粪石性小肠梗阻的临床价值。

方法

回顾性分析2017年6月至2020年6月收治并进行手术治疗的48例急性粪石性小肠梗阻患者的临床资料，根据手术方式不同分为两组，腹腔镜组（n=26例）及开腹组（n=22例）。腹腔镜组患者急诊腹腔镜下小肠切开取石，术中在梗阻近端小肠行小肠阻断；开腹组患者急诊行剖腹探查，术中行小肠切开取石。应用SPSS 21.0统计软件进行数据统计分析，围手术期各项指标等计量资料以（

x ˉ

±s）表示，采用独立样本t检验；术后并发症发生率等计数资料采用χ²检验。P<0.05为差异有统计学意义。

结果

腹腔镜组患者手术时间比开腹组长，差异有统计学意义（P<0.05）；术中出血量、排气时间、住院天数比开腹组患者明显减少，差异有统计学意义（P<0.05）。腹腔镜组患者术后并发症发生率（3.8%）明显少于开腹组（18.2%），差异有统计学意义（P<0.05）。

结论

相对于开腹手术，腹腔镜手术联合术中小肠阻断在治疗粪石性小肠梗阻可明显减少术中出血、住院时间、术后并发症的发生，效果显著，是一种安全有效的治疗方法。

关键词: 肠梗阻, 粪石嵌顿, 腹腔镜, 小肠阻断

Objective

To investigate the clinical value of laparoscopic small bowel lithotomy combined with intraoperative small bowel blocking in the treatment of acute coprolitith small bowel obstruction.

Methods

The clinical data of 48 patients with acute bezoar-induced small bowel obstruction who were treated and operated from June 2017 to June 2020 were retrospectively analyzed. According to different operation methods，they were divided into two groups，laparoscopy group（n=26）and laparotomy group（n=22）. In the laparoscopic group，emergency laparoscopic enterotomy for stone removal was performed，and small intestinal obstruction was performed at the proximal end of the small intestine. Patients in the laparotomy group received emergency exploratory laparotomy and small bowel incision for stone extraction. SPSS 21.0 statistical software was used for data statistical analysis.The perioperative indicators and other measurement data were expressed as（

x ˉ

±s），and independent sample t test was used. χ² test was used for isometric data of postoperative complications. P<0.05 was considered statistically significant.

Results

The operation time in laparoscopy group was longer than that of laparotomy group，and the difference was statistically significant（P<0.05）；Volume of blood loss，exhaust time and hospitalization time were significantly lower than those in the laparotomy group. The difference was statistically significant（P<0.05）. The complication rate in laparoscopy group was 3.8%，which was significantly lower than that of laparotomy group（18.2%，），and the difference was statistically significant（P<0.05）.

Conclusion

Compared with laparotomy，laparoscopic surgery combined with intraoperative small bowel obstruction can significantly reduce intraoperative bleeding，postoperative hospitalization time，and postoperative complications. It is a safe and effective treatment method.

Key words: Intestinal obstruction, Fecal impaction, Laparoscopes, Small bowel block

表1 48例急性粪石性小肠梗阻不同术式两组患者一般资料比较[(

x ˉ

±s),例]

组别

例

性别

男/女

年龄

(岁)

粪石大小

(cm)

粪石至回盲部距离（cm）

开腹组

9/13

63.8±13.3

4.0±0.7

127.5±83.5

腹腔镜组

12/14

58.9±10.4

3.8±0.9

123.9±86.1

>0.05