腹腔镜在胃肠穿孔治疗中102例临床体会.docVIP

腹腔镜在胃肠穿孔治疗中102例临床体会 　　摘要：目的 探讨腹腔镜在治疗胃肠穿孔患者中的临床应用价值。方法 对我院2012年1月～2015年2月采用腹腔镜下胃肠穿孔修补术治疗的102例胃肠穿孔患者为研究对象，其中90例胃、十二指肠溃疡穿孔采用腹腔镜下全层缝合结扎，再加盖大网膜后原结扎线结扎固定；5例小肠穿孔在腹腔镜下全层缝合，7例在腹腔镜下探明病变部位后于近邻腹壁开一小切口手术。结果 90例胃、十二指肠溃疡穿孔及5例小肠穿孔均在腹腔镜下完成修补，7例小肠穿孔在腹腔镜协助下开腹完成修补术。手术时间35～90 min，平均（51.6±21.1）min，出血量平均为（8.2±3.1）ml；术后3～5 d开始进流质，平均住院时间为（6.8±2.1）d，术后无明显并发症发生。结论 腹腔镜治疗胃肠穿孔具有创伤小、腹腔冲洗彻底、对腹腔脏器干扰小，术后肠粘连等并发症明显减少、恢复快、患者痛苦轻等优点。 　　关键词：胃肠穿孔；腹腔镜；修补术 　　Abstract：Objective To investigate the clinical application of laparoscopy in the treatment of patients with gastrointestinal perforation.Methods In our hospital between January 2012 and February 2012，the laparoscopic gastrointestinal perforation repair treatment of 102 patients with gastrointestinal perforation as the research object， including 90 cases of gastric and duodenal ulcer perforation with laparoscopy full-thickness suture ligation， then after sealed by the greater omentum ligature ligature fixation；5 cases of small intestinal perforation in laparoscopic full-thickness suture，7 cases of pathological changes of proven in laparoscopic neighbor to open a small incision after operation.Results 90 cases of gastric and duodenal ulcer perforation and 5 cases of small intestinal perforation are completed under laparoscopic repair， 7 cases of small intestinal perforation complete repair of the laparoscopic assisted by laparotomy. Operation time， 35～90 min， an average of （51.6±21.1）min， the bleeding with an average of （8.2±3.1） ml； After 3～5 d start into the liquid， and the average length of hospital stay was （6.8±2.1）days， no significant postoperative complications. Conclusion laparoscopic treatment of gastrointestinal perforation， small trauma， abdominal rinse thoroughly， little interference of abdominal viscera， significantly reduce the postoperative intestinal adhesions and other complications， rapid recovery， light pain， etc. 　　Key words：Gastrointestinal perforation；Laparoscope；Repair 　　胃肠穿孔是常见的外科急腹症之一，患者多有胃十二指肠溃疡或腹部外伤病史，临床表现一般比较典型，多为持续性剧痛，疼痛从