腹腔镜探查和剖腹探查诊治腹部闭合性损伤的临床比较

【】目的 比较腹腔镜探查和剖腹探查诊治腹部闭合性损伤的临床疗效。方法 选取2012年1月至2016年12月我院收治的65例腹部闭合性损伤患者,其中行腹腔镜探查术30例(腹腔镜组),行剖腹探查术(开腹组)35例(剖腹组)。比较两组患者的手术相关情况及围手术期应激指标的变化。结果 两组患者均得到了准确的诊断并进行了有效的治疗。腹腔镜组中有4例(13.33%)患者中转开腹。两组患者的手术阴性率和手术时间比较,差异无统计学意义(均P>0.05)。腹腔镜组的术后下床时间、术后通气时间、术后疼痛时间、术后住院时间均要少于或早于开腹组,差异有统计学意义(均P<0.05)。两组患者术前血清皮质醇、IL-6、CRP水平差异无统计学意义(均P>0.05)。腹腔镜组术后24h血清皮质醇、IL-6、CRP水平较同组术前水平差异无统计学意义(均P>0.05),但低于开腹组术后24h水平,差异有统计学意义(均P<0.05)。开腹组术后24h血清皮质醇、IL-6、CRP水平较术前明显升高,差异亦有统计学意义(均P<0.05)。结论 腹腔镜探查术诊治腹部闭合性损伤安全而有效,可减轻患者术后应激反应和促进术后恢复,但需把握中转开腹指征。

Laparoscopic versus open exploration in patients with abdominal closed injury

Objective To compare the clinical effects between laparoscopic and open exploration in treating abdominal closed injury. Methods The clinical data of 65 patients with abdominal closed injury from Jan. 2012 to Dec. 2016 were reviewed. They were divided into laparoscopic group (n=30) underwent laparoscopic exploration and open group (n=35) underwent open exploration. The condition related to surgery and stress indices postoperatively were compared. Results All of patients were diagnosed accurately and treated effectively. In the laparoscopic group, 4 cases were converted to open surgery. No difference in the negative rate of surgery and operative time between the two groups were found (All P>0.05). In the laparoscopic group, the postoperative activity time, postoperative exhaust time, pain duration, and hospital stay were less than those in the control group (All P<0.05). The difference in the preoperative level of serum cortisol, IL-6 and CRP between the two group were not statistical (All P>0.05). The level of three stress indices on 24 h postoperatively in the two groups were higher than those preoperatively, but only the difference in the open group was statistical (All P<0.05). In the laparoscopic group, the level of serum cortisol, IL-6 and CRP on 24 h postoperatively were lower than those in the open group (All P<0.05). Conclusions Laparoscopic exploration for patients with abdominal closed injury is safe and feasible. Compared to open procedure,laparoscopic exploration can alleviate postoperative stress reaction and promote postoperative recovery. But surgeons should grasp converted indications.