腹腔镜下全小肠探查及腹腔镜辅助下小肠部分切除术

目的探讨腹腔镜下全小肠探查及小肠部分切除的临床价值。方法回顾性分析1996年10月～2008年3月17例全小肠探查及其中4例行小肠部分切除术的临床资料。结果17例腹腔镜下探查均顺利完成。4例腹腔镜辅助下小肠部分切除（胃切除术后小肠粘连成角1例;疑小肠肿瘤1例,术后病理为结核性肉芽肿;胆囊结石同时患小肠梗阻1例;末端回肠克罗恩病1例）。探查出阳性结果未手术2例（末端回肠先天性狭窄1例择期手术,多发性肠息肉并多发性肠套迭1例拒绝手术）。余11例均在镜下顺利分离肠粘连。13例随访8个月～5年,平均3年,11例肠粘连松解术后,腹痛症状未再复发,1例克罗恩病、1例末端回肠结核性肉芽肿无不适症状。结论腹腔镜下全小肠探查对小肠疾病诊断安全、快速、可靠,定位准确,发现病灶后可在腹腔镜辅助下小肠部分切除,使诊治一体化。     

腹腔镜粘连松解术治疗术后粘连性小肠梗阻疗效观察

正粘连性小肠梗阻多数可保守治疗,如存在粘连索带牵拉肠管成角、压迫肠管、形成内疝或肠袢扭转等因素,则需手术治疗。开腹肠粘连松解手术创伤大且术后容易形成新的粘连,而腹腔镜手术具有创伤小、恢复快、对腹腔干扰小、并发症少等优点。2013年10月~2015年5月我科对12例急性粘连性小肠梗阻患者行腹腔镜肠粘连松解术,疗效满意,报告如下。对象与方法一、对象本组12例患者中男6例,女6例,年龄17~74岁,平均年     

腹腔镜诊治小儿胃肠重复畸形的临床应用

目的探讨腹腔镜下诊断和治疗胃肠重复畸形的价值。方法6例术前初步诊断胃肠重复畸形患儿行腹腔镜探查,确诊胃小肠重复畸形后,经脐部trocar切口提出畸形病变,在腹腔外行保留主肠管单纯切除重复畸形和重复畸形与附着肠管一并切除加肠吻合术;全结肠重复畸形采取在全腹腔镜下做结肠内引流术。结果6例手术均成功,手术时间90～150 min,平均120 min,无术中大出血、意外损伤及围手术期死亡病例,术后4～6天出院。术后随访3个月～2年,平均11个月,患儿生长发育良好,无肠粘连、肠梗阻。结论腹腔镜对小儿胃肠重复畸形具有诊断意义,同时也是治疗胃肠重复畸形的行之有效的方法。     

腹腔镜在小肠不全梗阻手术中的应用

目的探讨腹腔镜治疗小肠不全梗阻的可行性及临床效果。方法回顾性分析2011年1月~2016年1月85例肠梗阻资料。5例因腹腔束带粘连导致梗阻,腹腔镜下切断束带解除梗阻;75例因小肠与小肠、腹壁、盆腔粘连、成角导致梗阻,腹腔镜下分离粘连、成角解除梗阻;3例探查发现阑尾炎导致梗阻,行阑尾切除术;2例因肠腔异物导致梗阻,腹腔镜下取出异物。腹胀明显者术前留置肠梗阻导管减轻腹胀。结果除2例局部粘连广泛、致密做小切口辅助手术切除部分肠管行端端吻合外,均在腹腔镜下完成,无并发症发生。术后随访3~60个月,平均35个月,未见梗阻症状复发。结论腹腔镜治疗小肠梗阻是可行的,具有切口小、创伤轻、恢复快、术后住院时间短等微创特点,避免开腹手术造成的创伤。     

腹腔镜联合双气囊小肠镜在小肠出血中的诊断和治疗

目的评价腹腔镜对小肠出血的诊断与治疗。方法回顾性分析2003年9月～2005年12月间39例腹腔镜诊治小肠出血的临床资料,并对腹腔镜手术时间、术中失血、切口长度、术后排气时间、术后住院天数、并发症进行统计分析。结果腹腔镜不仅明确所有39例小肠出血的诊断,而且同时实施相应的腹腔镜手术。腹腔镜手术时间为70.3±32.6min,术中失血为16.1±12.4ml,切口长度为3.6±1.3cm,术后排气时间为2.3±0.8d,术后住院天数为7.9±3.1d。2例(5.1%)术后出现吻合口糜烂出血和束带粘连性小肠梗阻的并发症。结论腹腔镜不仅对小肠出血具有很高的诊断价值,而且可以实施安全、可行、微创的手术治疗。     

腹腔镜辅助下急性机械性小肠梗阻的治疗

目的探讨腹腔镜辅助在治疗急性机械性小肠梗阻的作用。方法回顾性分析1999年1月-2005年4月10例急性机械性小肠梗阻病例的临床资料。结果10例均在腹腔镜探查中明确诊断，并明确梗阻部位及病因，在腹腔镜辅助下顺利完成手术，无须扩大切口探查和处理。手术时间20-50min，平均34min。胃肠恢复时间20-36h，平均25．4h。术后住院2-4d，平均2．8d，全部治愈。无术后并发症。6例随访6-12个月，平均9个月，均未见梗阻复发。结论在腹腔镜辅助下，急性机械性小肠梗阻实施微创治疗不仅可以及时明确诊断，而且镜下决定开腹手术最佳位置、选择最小切口、采取最适当的手术方式。     

腹腔镜阑尾切除术后再手术原因分析

目的 分析腹腔镜阑尾炎手术后再手术的原因,探讨腹腔镜阑尾炎手术中应注意的事项.方法 2003年5月~2013年3月,发生11例腹腔镜阑尾切除术后再手术.急性阑尾炎10例,慢性阑尾炎1例.再手术原因：腹腔脓肿4例,回盲部肿瘤1例,腹腔大出血并休克1例,腹膜后血肿1例,小肠漏1例,肠粘连1例,盆腔炎1例,胰腺炎1例.经保守治疗无效,8例行腹腔镜探查,3例开腹探查.结果 二次手术均成功.腹腔脓肿4例行腹腔镜脓肿清洗引流,腹腔大出血并休克1例行腹腔镜探查腹壁下动脉结扎,肠粘连1例行腹腔镜探查粘连带松解,盆腔炎1例行腹腔镜盆腔冲洗引流＋抗感染治疗,胰腺炎1例行腹腔镜胰腺被膜打开胰腺周围置管引流;小肠漏1例行腹腔镜探查＋开腹小肠肠管部分切除吻合术,腹膜后血肿1例行开腹探查阑尾动脉结扎,回盲部肿瘤1例行开腹右半结肠切除术（病理高分化腺癌）.术后7~21天痊愈出院.结论 腹腔镜下阑尾切除术后再手术的原因为：术前术中漏诊、误诊;术中脓液清洗不彻底,术后引流不通畅致腹腔脓肿形成;术中操作不规范,致腹壁下血管、阑尾动脉出血.腹腔镜阑尾切除术应注意规范操作,术中应探查仔细,防止漏诊、误诊.     

应用肠梗阻导管术中小肠内排列治疗粘连性肠梗阻

目的探讨肠梗阻导管经由自然孔道行小肠排列治疗粘连性小肠梗阻和预防梗阻复发的适应证、方法和疗效。方法 2007年7月至2011年9月,共纳入需手术治疗的粘连性肠梗阻患者21例。术前诊断:肠粘连松解术后15例,宫外孕术后1例,直肠Dixon术后1例,先天性小肠旋转不良1例,腹茧症1例,阑尾穿孔切除术后2例。手术方式:肠粘连松解术9例,肠粘连松解+小肠部分切除术10例,肠粘连松解术及横结肠造口术1例,末端回肠造口术1例。术中同时置入肠梗阻导管经鼻行小肠内排列,术中引导至末端回肠。患者常规治疗包括:禁食、纠正水电解质和酸碱失衡、营养治疗,支持治疗等。结果术中成功置管20例粘连性小肠梗阻患者,1例置管未成功。平均置管时间(15±9)min。平均胃肠减压量为:(502±114)ml/d;全组患者术后平均(4.4±3.2)d排气,术后(6.2±2.2)d开始带管进流食。术后平均(14.7±7.6)d拔管,术后均顺利拔管。置管期间并发症发生率15.0%(3/20):2例切口感染;1例鼻咽炎。术后随访20例5～40个月,2例(10.0%)在术后6个月内出现间断腹胀,经对症治疗后缓解。治愈率为90.0%,无因肠梗阻而再手术病例。结论在肠粘连松解和肠切除的基础上,应用肠梗阻导管进行小肠内排列术,操作简单,微创,疗效可靠。可明显改善粘连性肠梗阻患者症状,降低肠梗阻的复发率。在严格掌握适应证的前提下,可作为小肠内排列的选择术式之一。     

腹腔镜在粪石性小肠梗阻中的应用

目的探讨腹腔镜手术治疗粪石性小肠梗阻的临床价值。方法2011年5月～2013年11月对17例粪石性小肠梗阻在腹腔镜下找到梗阻部位,明确粪石性肠梗阻诊断后,以无损伤肠钳将粪石轻柔捏挤,然后将碎块连同肠内容物推挤过回盲瓣,检查梗阻近端肠管无粪石后结束手术。结果16例腹腔镜手术获成功,1例因粪石大且坚硬,嵌顿在肠管无法推动,反复在同一部位挤压粪石导致水肿肠管浆膜破裂,中转开放手术。腹腔镜手术时间12～29rain,平均21rain。16例术后住院2—6d,平均4．2d。术后随访3～6个月,腹腔镜手术成功患者无腹腔脓肿、肠漏、粘连性肠梗阻、切口感染等并发症,腹部瘢痕不明显。结论腹腔镜诊治粪石性小肠梗阻安全、简单、有效。     

腹腔镜下处理粘连性肠梗阻的体会

目的探讨应用腹腔镜技术诊治粘连性肠梗阻的价值。方法利用腹腔镜粘连松解术治疗粘连性肠梗阻20例,用电凝、分离钳、分离剪及超声刀分离、切断粘连带。结果本组腹腔镜手术成功18例,加用辅助小切口行病变段小肠切除、肠吻合术2例。平均手术时间70min,术中出血10-50ml。本组无手术死亡病例及其他并发症发生。随防1～36个月,无梗阻症状复发。结论腹腔镜肠粘连松解术具有手术时间短、病人创伤小、出血少、术后康复快、并发症少、住院时间短等优点。     

Elective laparoscopy in diagnosis and treatment of recurrent small bowel obstruction

BACKGROUND: To evaluate the feasibility, efficacy, and safety of laparoscopy in diagnosis and treatment of recurrent small bowel obstruction. METHODS: Retrospective analysis of 253 patients who underwent therapeutic laparoscopy for recurrent small bowel obstruction from June 1996 to May 2005 was carried out. Patients with acute small bowel obstruction, bowel obstruction due to tumor, and obstructed inguinal hernias were excluded from analysis. RESULTS: Laparoscopy diagnosed cause of obstruction in all except 3 (1.18%) patients. The etiology included adhesions (38%), incarcerated ventral incisional hernias (32%), Meckel diverticulum (7%), stricture (14%), volvulus (3%), intussusception (4%). One hundred sixty nine patients were managed totally laparoscopically with adhesiolysis. Therapeutic bowel intervention other than adhesiolysis was required in 84 patients, of which 33 procedures were performed totally laparoscopically and remaining 51 procedures were completed with laparoscopically guided target incision. Five patients required conversion to open celiotomy. Iatrogenic enterotomies occurred in 3 patients and small bowel perforation during manipulation occurred in 1 patient. Postoperative procedure-related complications were seen in 44 patients. There was one mortality due to postoperative arrhythmia and cardiac failure. CONCLUSIONS: Laparoscopic diagnosis and treatment of recurrent small bowel obstruction is feasible, safe, and can be performed electively in selected cases.     

Laparoscopic approach to postoperative adhesive obstruction

Background Some authors have assessed the feasibility of laparoscopy in the treatment of postoperative adhesive obstruction, but conclusions about its effectiveness are related to different selection criteria used for surgery. This paper reports on our experience in laparoscopic adhesiolysis and analyses the results on the basis of the selection criteria used.Methods From January 1993 to December 2001, 65 patients were submitted to laparoscopic adhesiolysis for small bowel obstruction according to specific selection criteria. Of the 65 patients, 40 were admitted for acute obstruction and 25 for chronic or recurrent transit disturbances. Correlation between historical and clinical data and the results of surgical treatment were statistically analyzed.Results The procedure was completed by laparoscopy in 52 patients (conversion rate: 20%). Mean postoperative stay was 4.4 days with a 12.3% morbidity and no mortality. Recurrence rate was 15.4%; a single correlation was found between recurrence and age.Conclusions Laparoscopic adhesiolysis in the treatment of small bowel obstructions seems to be effective; further studies are required to define selection criteria for surgery and confirm real advantages in terms of recurrences.     

Laparoscopic approach to small bowel obstruction

Historically, laparotomy and open adhesiolysis have been the treatment of choice for patients requiring surgery with small bowel obstruction (SBO), although laparotomy itself is an independent risk factor for bowel obstruction. Laparoscopy is known to create fewer intra-abdominal adhesions than open laparotomy. The observation that many patients with SBO have isolated adhesive bands has led to the use of laparoscopy as primary treatment of SBO by some authors. Although the laparoscopic approach to SBO has been described, the outcomes and indications are not well established. We will review the available literature regarding the laparoscopic approach to SBO. Additionally, we will describe the technique and make recommendations regarding which patients may be best suited for a trial of laparoscopy for adhesiolysis.     

Laparoscopic adhesiolysis in acute small bowel obstruction: a preliminary experience.

OBJECTIVE: The aim of this study is to evaluate laparoscopy as another tool for management of cases of adhesive acute small bowel obstruction. METHODS: Fourteen patients suffering from suspected adhesive small bowel obstruction were explored laparoscopically over a period of 24 months. The Veress needle was inserted either in a virgin part of the abdomen away from previous scars or under direct vision using an open technique. Careful inspection of the entire abdomen was done, and the small bowel was "run" in a retrograde fashion starting at the cecum. The point of obstruction was localized and adhesiolysis was performed, thus resolving the problem. RESULTS: Laparoscopic exploration was able to determine the site and cause of obstruction precisely in all 14 cases, with resolution of the problem laparoscopically in 12 patients (85.7%). Two cases were converted to open surgery (14.3%). There were no mortalities and low morbidity (7.1%). The mean hospital stay was 3.7 days. CONCLUSION: Laparoscopic surgery can be an advantageous alternative to open surgery in acute small bowel obstruction, thus providing a new technique for its diagnosis and treatment with all the advantages of minimally invasive surgery.     

Laparoscopic treatment of small intestine obstruction]

Laparoscopic surgery for small bowel obstruction is still under evaluation. A review of the literature retrieved over 200 published cases. Technically, the open laparoscopy procedure seems mandatory to avoid bowel injuries. Grasping the enlarged bowel and using monopolar cautery should be avoided. The surgeon should also be sure that at the end of the procedure adhesiolysis was correct. Evaluation of the results must also take into account that most studies were retrospective and included few patients. The cumulative effectiveness rate of laparoscopy was 60%. Failures were mainly due to multiple adhesions, iatrogenic perforations to the intestine, and colonic cancers not recognized before the procedure. There was no prospective study comparing laparoscopy with laparotomy. Finally, it is not proved at present that laparoscopy prevents the recurrence of adhesions after digestive surgery. Owing to the results of the literature, laparoscopic surgery for acute small bowel obstruction does not appear as based on fact.     

The role of laparoscopic adhesiolysis in the treatment of patients with chronic abdominal pain or recurrent bowel obstruction.

BACKGROUND: Major abdominal operations result in random and unpredictable scar tissue formation. Intraabdominal scar tissue may contribute to recurrent episodes of bowel obstruction, chronic abdominal pain, or both. Laparoscopic adhesiolysis may provide relief of symptoms in patients with prior abdominal surgery with chronic abdominal pain or recurrent bowel obstruction. METHODS: Between September 1996 and April 1999, 35 patients underwent laparoscopic adhesiolysis. Fifteen of the patients had adhesiolysis in conjunction with other major laparoscopic procedures and were excluded from the study. Twenty of the patients who underwent adhesiolysis only were retrospectively assessed for symptomatic relief as well as peri-operative morbidity and mortality. RESULTS: Two of 20 patients were not available for long-term follow-up. In the 18 remaining patients, laparoscopic adhesiolysis was performed on 13 patients with abdominal pain and 5 patients with recurrent bowel obstruction. The follow-up period ranged from 1 to 32 (mean 11) months. Sixteen of the 18 (88.9%) operations were completed laparoscopically. Two operations were converted to open for partial enterectomy. An additional enterotomy was repaired laparoscopically. All 3 operative complications were encountered in patients operated on during hospitalization for active bowel obstruction. No mortalities or blood transfusions occurred. One patient required rehospitalization for nonoperative management of an intraabdominal hematoma. Fourteen of the 18 (77.8%) had subjective improvement in their quality of life after operation. Only 1 patient has required repeat adhesiolysis. CONCLUSIONS: Laparoscopic adhesiolysis is a safe and effective management option for patients with prior abdominal surgery with chronic abdominal pain or recurrent bowel obstruction not attributed to other intraabdominal pathology. Laparoscopic intervention in patients with active bowel obstruction may increase the risk of operative complications.     

Laparoscopic management of acute small bowel obstruction

BACKGROUND: Conventional surgical management of acute small bowel obstruction involves laparotomy. The laparoscopic approach has not been favoured due to the presumed increased risk of bowel injury. METHODS: A retrospective review of our experience of laparoscopic management of acute small bowel obstruction was undertaken. Nine patients were identified from 1997 to 2003. The aetiology of obstruction was identified laparoscopically in all cases. Eight cases were caused by bands or local adhesions and one patient had a bezoar. RESULTS: Laparoscopic treatment was successful in 78% of patients including one laparoscopy-assisted procedure. Conversion to laparotomy was performed in two patients, one due to difficult adhesiolysis and one due to iatrogenic bowel injury during adhesiolysis. The mean operating time was 74 minutes. There were no postoperative complications and the mean length of hospital stay was 4.3 days. CONCLUSION: This small series demonstrates that laparoscopy can serve as a good diagnostic tool as well as treatment of acute small bowel obstruction. In an appropriately selected patient, laparoscopic management of small bowel obstruction is a feasible therapeutic approach and appears to convey the benefits of a short postoperative hospital stay, reduced postoperative complications and possibly reduced subsequent adhesion formation.     

Enteroclysis-guided laparoscopic adhesiolysis in recurrent adhesive small bowel obstructions

The aim of this study was to point out the efficiency of enteroclysis assay in localization of intraabdominal adhesions that impede small bowel transit in patients with recurrent adhesive small bowel obstruction who underwent laparoscopic partial adhesiolysis. Between January 1998 and June 2001, 15 selected patients with recurrent adhesive small bowel obstructions were treated successfully by medical means and evaluated with enteroclysis to define the pathologic adhesive site that impeded bowel transit. If the results of enteroclysis were indicative, they underwent laparoscopic partial adhesiolysis. The mean duration of the laparoscopic procedure was 99 minutes. In one patient conversion to laparotomy occurred because of excessive adhesions, and in another patient a small bowel injury occurred and enterorrhaphy was performed laparoscopically. Mean postoperative hospital stay was 4 days. During a mean follow-up of 17.2 months (range, 6-39), there was no delayed morbidity or recurrence. Identification of the small bowel site of recurrent obstruction with enteroclysis permits limited laparoscopic adhesiolysis. This approach may be a rational alternative to not only open procedures but also complete laparoscopic adhesiolysis without enteroclysis.     

Laparoscopic adhesiolysis for small bowel obstruction

BACKGROUND: Historically, laparotomy and open adhesiolysis have been the treatment for patients requiring surgery for small bowel obstruction. Laparoscopic adhesiolysis has not gained wide acceptance. The indications and outcomes of laparoscopic adhesiolysis for small bowel obstruction are not well established. The purpose of this paper is to review the literature on laparoscopic adhesiolysis for small bowel obstruction and to discuss patient selection, surgical technique, and outcomes. DATA SOURCES: Medline search from 1980 to 2002. CONCLUSIONS: Laparoscopic adhesiolysis has been shown to be safe and feasible in experienced hands. For selected patients, laparoscopic adhesiolysis offers the advantages of decreased length of stay, faster return to full activity, and decreased morbidity. Patient selection and surgical judgment appear to be the most important factors for a successful outcome.     

Elective laparoscopy for small bowel obstruction

We performed elective laparoscopic adhesiolysis in 21 patients with small bowel obstruction. The procedure was completely laparoscopic or laparoscopy assisted in 17 patients, but 4 patients required full laparotomy due to internal hernia in 2, perforation of the small bowel associated with dense adhesions in 1, and carcinoma of the cecum in 1. In patients with a laparoscopic or laparoscopy-assisted procedure, the mean operating time, mean time until the return of bowel function, and mean postoperative stay were 94 minutes, 3.3 days, and 9.9 days, respectively. During follow-up for 14 to 44 months, 3 patients developed recurrent obstruction, 1 patient suffered from catheter-induced thrombosis, and 1 patient died from lung cancer. Elective laparoscopy can be performed safely and effectively in selected patients with intermittent small bowel obstruction.