Liauw Jennifer J Y, Cheah Wei-Keat
Minimally Invasive Surgical Centre, National University Hospital, Singapore.
Asian J Surg. 2005 Jul;28(3):185-8.
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.
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.
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.
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.
急性小肠梗阻的传统外科治疗方法是开腹手术。由于认为肠损伤风险增加，腹腔镜手术方法一直未受青睐。
对我们采用腹腔镜治疗急性小肠梗阻的经验进行回顾性研究。从1997年至2003年共确定了9例患者。所有病例均通过腹腔镜确定梗阻病因。8例由束带或局部粘连引起，1例患者有胃石。
78%的患者腹腔镜治疗成功，其中包括1例腹腔镜辅助手术。2例患者中转开腹，1例因粘连松解困难，1例因粘连松解过程中发生医源性肠损伤。平均手术时间为74分钟。无术后并发症，平均住院时间为4.3天。
这个小系列研究表明，腹腔镜可作为急性小肠梗阻的良好诊断工具及治疗手段。对于经过适当选择的患者，腹腔镜治疗小肠梗阻是一种可行的治疗方法，似乎具有术后住院时间短、术后并发症减少以及可能减少后续粘连形成等优点。
