微创技术在粘连性肠梗阻诊治中的作用

Q4 Biochemistry, Genetics and Molecular Biology Sibirskii nauchnyi meditsinskii zhurnal Pub Date : 2023-08-30 DOI:10.18699/ssmj20230414
I. A. Yusubov
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引用次数: 0

摘要

术后严重的腹腔并发症之一是粘连源性肠梗阻(IOAO)。术后肠梗阻的死亡率为16.2-52.5%。研究目的——术后早期腹腔镜诊断IOAO并优化粘连松解术。材料和方法。术后早期对70例上消化道IOAO患者进行了检查和治疗;腹腔镜手术46例(主要组),开腹手术24例(对照组)。结果与讨论。研究表明,中上切口和中下切口剖腹产术更容易引起肠梗阻。术前超声诊断小肠环活动性粘壁粘连的敏感性为94.6%,腹腔镜诊断的敏感性为99.2%。与剖腹手术相比,使用微创技术时,术中并发症(分别为4(8.7%)和8(33.3%),p<0.05)和术后并发症(分别是5(10.9%)和13(54.1%),p>0.05)、死亡率(分别是0和4(16.6%),p<0.05)以及住院时间(5.7(3-8)和14.3(10-17)天,p<0,05)的发生率较低。结论。对于I-II级粘连过程的患者,使用腹腔镜粘连松解术和抗粘连屏障是合适的。在腹腔镜粘连松解术中出现技术困难的情况下,通过小切口分离粘连在病因上更为合理。如果无法做到这一点,建议采取复杂的抗粘连措施,包括转为剖腹手术和粘连松解后的全身酶治疗。
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The role of minimally invasive technologies in the diagnosis and treatment of adhezive intestinal obstruction
One of the serious intra-abdominal complications after surgery is intestinal obstruction of adhesion origin (IOAO). Mortality during postoperative intestinal obstruction is 16.2–52.5 %. Aim of the study – laparoscopic diagnosis of IOAO in the early postoperative period and optimization of adhesiolysis.Material and methods. In the early postoperative period 70 patients with IOAO of upper gastrointestinal tract were examined and treated; laparoscopic operation was performed to 46 patients (the main group), an open method (laparotomy) – to 24 patients (the control group).Results and discussion. It was revealed that upper-middle and lower-middle incision laparotomies are more likely to cause intestinal obstruction. The sensitivity of preoperative ultrasound diagnosis of movable visceroparietal adhesions of small intestinal loops is 94.6 %, and the sensitivity of laparoscopic diagnosis is 99.2 %. When using minimally invasive technology, the frequency of intraoperative (4 (8.7 %) and 8 (33.3 %), respectively, p < 0.05) and postoperative complications (5 (10.9 %) and 13 (54.1 %), p < 0.05), mortality (0 and 4 (16.6 %), p < 0.05) and length of stay in hospital (5.7 (3–8) and 14.3 (10–17) days, p < 0,05) was less compared to laparotomy.Conclusions. Using of laparoscopic adhesiolysis and anti-adhesion barrier is appropriate in patients with I-II grade adhesion process. In cases where technical difficulties arise during laparoscopic adhesiolysis, it is more pathogenetically justified to separate adhesions by passing through a mini-laparotomy incision. If this is not possible, it is advisable to perform complex anti-adhesion measures, including conversion to laparotomy and systemic enzymotherapy after adhesiolysis.
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0.40
自引率
0.00%
发文量
54
审稿时长
12 weeks
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