微创治疗粘连性肠梗阻

目的:探索中西医结合疗法与腹腔镜技术分阶段联合微创治疗粘连性肠梗阻的效果。方法:粘连性肠梗阻31例,在急性期以中西医结合疗法辨证施治,解除急性梗阻;缓解期行腹腔镜粘连松解术,根除梗阻。结果:31例急性期经中西医结合治疗,肠梗阻均解除。缓解期行腹腔镜粘连松解术,成功26例(83.9％);中转开腹手术5例(16.1％)。腹腔镜粘连松解术后胃肠功能恢复时间0.5-2d;术后住院2-4d。26例腹腔镜粘连松解术后随访,均未再发肠梗阻表现,治愈率100％。结论:中西医结合与腹腔镜联合微创治疗粘连性肠梗阻中转开腹率低,并发症发生率低,术后效果好,无再发梗阻。     

中西医结合微创治疗粘连性肠梗阻

目的：探索中西医结合与微创技术联合治疗粘连性肠梗阻的疗效。方法：31例粘连性肠梗阻，在急性期以中西医结合疗法辨证施治，解除急性梗阻；梗阻缓解后行腹腔镜粘连松解术，预防梗阻复发。结果：急性期经中西医结合治疗，肠梗阻均解除。缓解期行腹腔镜粘连松解术，成功26例（83．9％）；中转开腹手术5例（16．1％）。腹腔镜粘连松解术后胃肠功能恢复时间0．5－2d；术后住院时间2－4d。26例腹腔镜粘连松解术后随访（3个月－3年），均无肠梗阻复发的表现。结论：中西医结合微创治疗粘连性肠梗阻中转开腹率较低，并发症发生率低，术后效果好，无梗阻再发。     

三阶段中西医结合微创治疗急性粘连性肠梗阻

目的:建立分阶段中西医结合与腹腔镜微创手术联合治疗急性粘连性肠梗阻的方案,并评估该方案的可行性、有效性和优势.方法:39例急性粘连性肠梗阻,在急性期行中西医结合非手术治疗,在缓解期根据是否具备指征选用腹腔镜粘连松解术,术后再用中药治疗.施行上述三阶段治疗者为三阶段中西医结合微创治疗组.治疗后随访1年以上,比较治疗结果.结果:三阶段治疗组复发率5.1%,显著低于中西医结合非手术组的29.3%和开腹手术组的21.4%.结论:分阶段中西医结合微创联合治疗粘连性肠梗阻,效果明显优于其他任何单一治疗方式.     

腹腔镜治疗粘连性肠梗阻42例报告

目的:探讨腹腔镜下肠粘连松解术治疗粘连性肠梗阻的可行性及疗效。方法:总结2001年1月至2007年12月42例粘连性小肠梗阻患者行腹腔镜粘连松解术,并配合留置医用生物蛋白胶或透明质酸钠防止再粘连的临床资料。结果:40例应用腹腔镜成功实施粘连松解术,未出现手术并发症和过敏现象,随访3~36个月,无肠梗阻症状复发;2例中转开腹。结论:腹腔镜肠粘连松解术配合生物蛋白胶治疗粘连性肠梗阻安全实用,疗效满意,是处理粘连性肠梗阻的有效手段之一。     

腹腔镜在肠粘连松解术中的应用体会

目的探讨腹腔镜下肠粘连松解术治疗粘连性肠梗阻的应用价值。方法回顾分析32例粘连性肠梗阻行腹腔镜下肠粘连松解术的临床资料。结果26例腹腔镜下完成肠粘连松解术,4例在小切口辅助下完成手术,2例中转开腹手术。随访12-36月,均无肠梗阻复发。结论在掌握手术指征、规范操作及把握好中转开腹指征的前提下,腹腔镜手术治疗粘连性肠梗阻安全可行,具有创伤小、恢复快、再粘连率低等优点。     

腹腔镜在肠粘连松解术中的应用

目的:探讨腹腔镜在肠粘连松解术中的应用价值。方法:应用腹腔镜治疗粘连性肠梗阻患者11例。结果:7例成功利用腹腔镜完成肠粘连松解术,2例改为腹腔镜辅助下小切口肠粘连松解术,2例中转开腹。9例应用腹腔镜患者手术时间55~206m in,平均123m in,住院时间5~8d,平均7.1d。随访1~24个月(平均8个月),均无肠梗阻症状复发。结论:腹腔镜肠粘连松解术安全可行,具有临床应用价值。     

腹腔镜治疗小儿肠粘连26例报告

目的:探讨腹腔镜治疗小儿术后粘连性肠梗阻的可行性和适应证。方法:回顾分析1994年至2004年8月因粘连性肠梗阻行腹腔镜下肠粘连松解术26例的临床资料。结果:24例手术成功,2例中转开腹,无术后并发症,随访未见复发。结论:腹腔镜肠粘连松解术切口小、腹膜创面小,腹腔干扰少,能较大限度地减少术后腹腔内再粘连,为粘连性肠梗阻的外科治疗提供了一种新方法,不仅在成人,在小儿肠粘连中也可应用。     

粘连性肠梗阻腹腔镜肠粘连松解术手术方法选择

探讨粘连性肠梗阻急性期、恢复期实施腹腔镜松解术的效果.2016年12月—2019年12月,粘连性肠梗阻急性发作期实施腹腔镜下粘连松解术病例34例(对照组),粘连性肠梗阻恢复期择期实施腹腔镜下+辅助小切口肠粘连松解术病例71例中,随机选取34例(观察组),比较两组的手术情况.结果显示,观察组的中转开腹率、肠梗阻复发率、肠...     

腹腔镜在肠粘连松解术中的应用体会

目的:探讨腹腔镜肠粘连松解术治疗粘连性肠梗阻的应用价值。方法:回顾分析35例粘连性肠梗阻患者行腹腔镜肠粘连松解术的临床资料。结果:28例手术成功,效果良好,无并发症发生,随访12～60个月无复发。7例中转开腹,4例因肠管间团状粘连或板块状粘连,2例因术中分破肠壁,1例因肠管形成内疝致肠绞窄坏死。结论:腹腔镜肠粘连松解术在严格掌握手术适应证的前提下安全可靠,具有患者创伤小、痛苦轻、瘢痕小、康复快、治疗费用少等优点,且再粘连率低。     

腹腔镜肠粘连松解术治疗粘连性肠梗阻体会

目的总结腹腔镜下肠粘连松解术治疗粘连性肠梗阻的体会。方法采用腹腔镜下肠粘连松解术治疗26例腹腔手术后粘连性肠梗阻,对患者的诊治资料进行回顾性分析。结果本组26例患者中,22例顺利完成手术。手术时间34~145 min。患者术后第1天开始下床活动,术后26~48 h恢复肛门排气后,拔除胃管开始进流质食物。仅3例患者术后使用止痛剂。3例患者因肠袢致密粘连成团、腔镜下粘连松解困难,1例患者因多段小肠肠管与原腹壁切口致密粘连,松解时肠管多处损伤而中转开腹完成手术。术后未发生肠瘘、腹腔感染等并发症,住院时间4~9 d,顺利出院。随访6~12个月,无1例肠梗阻复发者。结论对非手术治疗无效的粘性梗阻患者,采用腹腔镜下肠粘连松解术,具有适应证宽、创伤小、对腹腔脏器干扰轻、术后患者胃肠功能恢复快、并发症少等优势。但必须把握好手术适应证和中转开腹的时机。     

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 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.     

Single-port laparoscopic management of adhesive small bowel obstruction

Laparoscopic adhesiolysis has been the focus of much recent attention; however, the role of single-port laparoscopic surgery for adhesive small bowel obstruction remains unclear. We report our experience of performing single-port laparoscopic surgery for adhesive small bowel obstruction through a retrospective review of 15 consecutive patients who underwent single-port laparoscopic surgery for single adhesive small bowel obstruction between 2010 and 2012. We analyzed data on patient demographics, operating time, conversion, and surgical morbidity. Surgery was completed successfully without conversion to laparotomy or the need for additional intraoperative ports in 14 patients, but the remaining patient had peritoneal dissemination from colon cancer. The median operative time was 49 (25–148) min, and the estimated blood loss was 19 (2–182) ml. There were no major postoperative complications. We conclude that single-port laparoscopic surgery is a technically feasible approach for selected patients with adhesive small bowel obstruction when preoperative imaging identifies a single adhesive obstruction.     

基层医院 1979 例急腹症的病种类型和诊治回顾性分析

目的：回顾性分析我院近年收治的急腹症的病谱、诊断情况、预后,总结急腹症各种疾病的发病谱、治疗经验。方法：对天津医科大学总医院滨海医院 2016 年 3 月—2019 年 3 月期间收治的 1979 例急腹症患者的临床资料进行回顾性分析。结果：急腹症的发病种类：从高到低依次为急性阑尾炎、胆道疾病、急性肠梗阻、急性胰腺炎、妇科急症、消化道穿孔、泌尿系结石、腹部创伤、其他 ( 胃潴留、不能确诊的腹痛 )。治疗现状：1979例急腹症患者中,保守治疗 1141 例（57.7%）,其中 74 例接受了中西医结合治疗;手术治疗 838 例（42.3%）,其中腹腔镜手术 349 例,开腹手术 489 例。结论：急腹症的临床表现特点为具有多样性、发病急,快速做出诊断,选择合理的治疗方式能够促进病情快速康复,提高治愈率。     

腹腔镜手术治疗急性粘连性肠梗阻(附22例报告)

目的 :探讨腹腔镜手术治疗急性粘连性肠梗阻的效果。方法 :回顾分析用腹腔镜治疗急性粘连性肠梗阻 2 2例的临床资料。结果 :19例在腹腔镜下完成 ,术后 4 ～5d出院 ;3例辅助小切口完成 ,局部小肠切除吻合 ,无并发症发生 ,术后 7～8d出院。结论 :在肠粘连急性发作期行腹腔镜手术是可行的。     

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。     

腹腔镜肠黏连松解联合应用生物蛋白胶治疗黏连性肠梗阻

目的探讨腹腔镜肠黏连松解联合应用生物蛋白胶治疗黏连性肠梗阻的可行性及其疗效。方法总结1998年5月至2003年10月间,28例黏连性小肠梗阻患者进行腹腔镜黏连松解术、并配合留置医用生物蛋白胶防止再黏连的临床资料。结果应用腹腔镜全组均成功实施黏连松解术解除肠梗阻,均于术中留置医用生物蛋白胶防止再黏连,未出现手术并发症和过敏现象;随访3～60个月,未发现肠梗阻症状复发。结论腹腔镜肠黏连松解术配合生物蛋白胶治疗黏连性肠梗阻安全实用,疗效满意,是处理黏连性肠梗阻的理想手段之一。