Omori Hiroaki, Asahi Hiroshi, Inoue Yoshihiro, Tono Chihiro, Irinoda Takashi, Saito Kazuyoshi
Critical Care and Emergency Center, Iwate Medical University, Morioka, Japan.
J Laparoendosc Adv Surg Tech A. 2003 Apr;13(2):83-8. doi: 10.1089/109264203764654696.
Recently, laparoscopy has been used as an effective diagnostic and therapeutic modality for traumatic injury and peritonitis. However, its clinical benefits are still under evaluation. The aim of this study was to assess the feasibility and safety of this technique, in comparison with traditional laparotomy, in the management of isolated bowel rupture. A further aim was to evaluate possible predictive clinical factors in the management of isolated bowel rupture.
Patients with definite or suspected isolated gastrointestinal perforation who were hemodynamically stable underwent laparoscopic surgery for diagnosis and treatment.
The traditional laparotomy control group (Group A, historical controls) included patients from a prior study. In this previous study, carried out between 1993 and 1997, 23 consecutive cases of traumatic gastrointestinal perforation were treated with traditional laparotomy. Retrospectively, 13 of these 23 cases would have been eligible for laparoscopic intervention. The laparoscopic group (group B) was made up of cases seen at our institution from 1998 to 2000. Of the 13 consecutive cases of traumatic gastrointestinal perforation, only one required immediate traditional laparotomy. Just one of the 12 cases of gastrointestinal perforation approached laparoscopically had to be converted to a traditional laparotomy. The following variables were evaluated in both groups: patient background, time from accident to onset of operation, operative time, blood loss, time to oral intake, incidence of peritoneal contamination, length of hospital stay, mortality, and intraoperative and postoperative complications. There were no statistical differences in age, gender ratio, and injury severity score (ISS). The mean operative times were 132.3 +/- 58.7 minutes and 143.6 +/- 27.3 minutes in group A and group B, respectively. The mean blood loss was 266.8 +/- 277.8 mL in group A and 57.6 +/- 57.1 mL in group B. The blood loss in group B was significantly lower (P =.0084) than that in group A. There were no significant differences in intraoperative and postoperative complications, hospital stay, and mortality between the two groups.
Laparoscopic intervention offers better results in the management of patients with blunt abdominal trauma and isolated bowel rupture.
最近，腹腔镜已被用作创伤性损伤和腹膜炎的一种有效诊断和治疗方式。然而，其临床益处仍在评估中。本研究的目的是评估与传统剖腹手术相比，该技术在单纯性肠破裂处理中的可行性和安全性。另一个目的是评估单纯性肠破裂处理中可能的预测性临床因素。
血流动力学稳定的明确或疑似单纯性胃肠道穿孔患者接受腹腔镜手术进行诊断和治疗。
传统剖腹手术对照组（A组，历史对照）包括先前一项研究中的患者。在1993年至1997年进行的这项先前研究中，23例连续性创伤性胃肠道穿孔患者接受了传统剖腹手术。回顾性分析，这23例患者中有13例符合腹腔镜干预条件。腹腔镜组（B组）由1998年至2000年在我们机构就诊的病例组成。在13例连续性创伤性胃肠道穿孔病例中，只有1例需要立即进行传统剖腹手术。在12例经腹腔镜处理的胃肠道穿孔病例中，只有1例不得不转为传统剖腹手术。对两组患者评估了以下变量：患者背景、事故至手术开始的时间、手术时间、失血量、开始经口进食的时间、腹腔污染发生率、住院时间、死亡率以及术中和术后并发症。在年龄、性别比例和损伤严重程度评分（ISS）方面无统计学差异。A组和B组的平均手术时间分别为132.3±58.7分钟和143.6±27.3分钟。A组的平均失血量为266.8±277.8毫升，B组为57.6±57.1毫升。B组的失血量显著低于A组（P = 0.0084）。两组在术中和术后并发症、住院时间和死亡率方面无显著差异。
腹腔镜干预在钝性腹部创伤和单纯性肠破裂患者的处理中效果更佳。
