急腹症行腹腔镜手术失败后再手术原因分析

目的分析急腹症患者行腹腔镜手术失败的原因,探讨腹腔镜急腹症手术中应注意的事项。方法回顾性分析2006年5月至2011年3月间广东省惠州市中心人民医院收治的17例急腹症行腹腔镜手术后失败再手术患者的临床资料。结果17例再手术患者中男11例．女6例,年龄16～68岁：上消化道穿孔修补术后8例,阑尾切除术后8例,消化道出血行小肠部分切除术后1例。再手术原因：腹腔脓肿13例,其中4例合并内瘘;回盲部牙签异物残留1例;回盲部淋巴瘤并梗阻1例：右侧闭孔疝1例：小肠血管畸形出血1例。12例患者经保守治疗无效后行再次腹腔镜探查手术,其中5例顺利完成腹腔镜手术,7例中转开腹手术;另有5例行急诊开腹探查手术。所有患者均救治成功,术后7～21d痊愈出院。结论腹腔镜技术应用于外科急腹症时,须严格掌握腔镜探查指征和遵循手术操作规范．对于病情特殊、诊断及手术有难度者应及时中转开腹。

Reason analysis of reoperation after failed laparoscopic surgery for acute abdomen

Objective To analyze the reasons for reoperation after failed laparoscopic surgery for acute abdomen. Methods A retrospective study was performed to review the clinical data of 17 patients who required reoperation after laparoscopic surgery from May 2006 to March 2011. Results There were 11 males and 6 females with 16-68 years old. The reasons for reoperation were as follows： 13 with abdominal abscess among whom 4 complicated with internal fistula, 1 with residual toothpick, 1 with ileoeecal lymphadenoma complicated with bowel obstruction, 1 with obturator hernia, I with intestinal vascular malformation. Twelve patients underwent laparoscopic reoperation after conservative treatments were invalid, among whom 5 completed laparoscopic operation successfully and 7 conversed to laparotomy. The other 5 patients underwent emergency abdominal operation. All the patients were cured and discharged from hospital 7-21 days postoperatively. Conclusion The laparoscopic technique has unique advantages, but must strictly adhere to the indications of Laparoscopic exploration and strictly follow the surgical operation procedures. In the special condition,and in diagnosis and surgery difficultly, laparoscopie surgery should be timely and decisive conversion to open surgery in the diagnosis and treatment of surgical acute abdomen.