肠梗阻导管联合腹腔镜手术治疗急性粘连性肠梗阻的疗效分析

目的比较肠梗阻导管联合腹腔镜手术与开腹手术治疗急性粘连性肠梗阻的疗效差别。方法 84例急性粘连性肠梗阻患者,根据治疗方式的不同分为对照组与实验组,各42例。对照组采用开腹手术治疗,实验组采用肠梗阻导管联合腹腔镜手术治疗。比较两组治疗情况,手术相关指标,并发症发生情况(包括切口感染及肺炎等近期并发症),随访情况包括术前住院时间、术后住院时间、住院费用(包括医保报销在内的住院费用)、1年复发率]。结果所有患者均痊愈出院,无围手术期死亡病例。实验组完全腹腔镜手术完成32例,辅助小切口完成7例, 3例因腹腔粘连过重而改行开腹探查术。对照组42例均行开腹手术,手术顺利。实验组的手术时间(125.3±35.2)min、排气时间(2.0±1.1)d均短于对照组的(141.2±27.1)min、(4.5±1.7)d,术中失血量(30.2±17.0)ml少于对照组的(85.2±42.1)ml,差异具有统计学意义(P<0.05)。实验组并发症发生率19.0%、1年复发率2.4%均低于对照组的40.5%、16.7%,术前住院时间(5.2±1.5)d长于对照组的(1.8±0.5)d、术后住院时间(4.5±1.7)d短于对照组的(8.3±2.1)d,差异均具有统计学意义(P<0.05);两组住院费用比较,差异无统计学意义(P>0.05)。结论对于急性粘连性肠梗阻,早期应用肠梗阻导管联合腹腔镜手术治疗,效果确切,创伤小,风险小,术后并发症少,值得临床推广。

Efficacy analysis of intestinal obstruction catheter combined with laparoscopic surgery in the treatment of acute adhesive intestinal obstruction

Objective To compare the difference in efficacy of intestinal obstruction catheter combined with laparoscopic surgery and laparotomy in the treatment of acute adhesive intestinal obstruction. Methods A total of 84 patients with acute adhesive intestinal obstruction were divided into control group and experimental group by different treatment methods, with 42 cases in each group. The control group received laparotomy, and the experimental group received intestinal obstruction catheter combined with laparoscopic surgery. The treatment status, surgical related indexes, occurrence of complications(incision infection and pneumonia) and follow-up hospitalization time before operation, hospitalization time after operation, hospitalization expenses(including medical insurance reimbursement), 1-year recurrence rate] were compared between the two groups. Results All patients recovered and were discharged without perioperative death cases. In the experimental group, 32 cases were completed with laparoscopic surgery, 7 cases were assisted with small incisions, and 3 cases were converted to open laparotomy due to excessive abdominal adhesions. All 42 patients in the control group underwent laparotomy, and the operation was smooth. The operation time(125.3±35.2) min and exhaust time(2.0±1.1) d in the experimental group was shorter than(141.2±27.1) min and(4.5±1.7) d in the control group, and amount of intraoperative hemorrhage(30.2±17.0) was less than(85.2±42.1) ml in the control group. Their difference was statistically significant(P<0.05). The incidence of complications 19.0% and 1-year recurrence rate 2.4% in the experimental group was lower than 40.5% and 16.7% in the control group, hospitalization time before operation(5.2±1.5) d was longer than(1.8±0.5) d in the control group, and hospitalization time after operation(4.5±1.7) d was shorter than(8.3±2.1) d in the control group. Their difference was statistically significant(P<0.05). There was no statistically significant difference in hospitalization costs between the two groups(P>0.05). Conclusion For acute adhesive intestinal obstruction, the early application of intestinal obstruction catheter combined with laparoscopic surgery is effective with little trauma, low risk and less postoperative complications. It is worthy of clinical promotion.