经腹腔镜粘连松解术治疗肠粘连的临床探讨.docVIP

精品论文 参考文献 经腹腔镜粘连松解术治疗肠粘连的临床探讨 何长洪（四川省隆昌县中医医院外三科 四川隆昌 642150） 【中图分类号】R574【文献标识码】A【文章编号】1672-5085（2012）13-0117-02 【摘要】目的 对肠粘连患者选择性施行腹腔镜下粘连松解术的可行性及方法进行探讨，并观察其临床效果。方法 通过对本院2002年至2011年间收治63例肠粘连病人的临床资料进行回顾性分析，选择性对其中34例诊断明确、临床症状基本缓解的粘连性肠梗阻患者，行择期腹腔镜下粘连松解术，配合留置“术尔泰”液于腹内防止术后再粘连。术中设定气腹压力为 11～15mm Hg，2～3个操作孔。其中单纯粘连带引起症状者切除粘连带，小肠与腹壁粘连成角及小肠网膜与腹壁粘连者用电凝分离剪、分离钳分离与腹壁的粘连。结果 34例患者中，28例腹腔镜下完成粘连松解术，2例因粘连致密分离困难中转开腹；2例不能造气腹中转开腹；1例分离时小肠破裂中转开腹；1例患者自己放弃手术。随访腹腔镜完成手术者3～12个月，无肠梗阻症状发生。结论 腹腔镜粘连松解术治疗肠粘连安全可行，临床效果可靠。具有创伤小、恢复快、并发症少、住院时间短以及术后再发粘连机会更低等优点。 【关键词】肠粘连 腹腔镜术 粘连松解术 肠梗阻 【Abstract】 Objective To discuss the feasibility and methods to treat intestinal adhesions with laparoscopic adhesiolysis and observe the clinical effects. Methods By reviewing the clinical data of 63 intestinal adhesion patients received and cured by our hospital from 2002 to 2011, laparoscopic adhesiolysis was performed in 34 patients with clinically diagnosed intestinal adhesion and improved clinical symptoms, with indwelling Perfect Solution available to prevent post-operation adhesion. The pneumoperitoneum pressure was set at 11～15mm Hg, with three holes available. Adhesion band was cut for those who suffered from pure adhesion band, while electric coagulation separating clamp was used to separate abdominal adhesion for patients whose small intestine formed an angle with abdominal wall and whose intestinal retinal was adhered to abdominal wall. Results 28 cases were performed laparoscopic adhesiolysis, two cases were converted to open procedure due to for failure in separating adhesion, two cases were converted to open procedure for failure in establishing pneumoperitoneum, one case was converted to open procedure for rupture of small intestine, and one patient gave up operation. There were no symptoms of intestinal obstruction three to 12 months following the operation. Conclusions Laparoscopic adhesiolysis is safe and effective on treating intestinal adhesions and has the advantages of less trauma, faster reco