腹腔镜手术在急性大肠梗阻治疗中的作用。

The role of laparoscopic surgery for the management of acute large bowel obstruction.

机构信息

Department of Colorectal Surgery, Frenchay Hospital, Bristol, UK.

出版信息

Colorectal Dis. 2011 Mar;13(3):263-6. doi: 10.1111/j.1463-1318.2009.02123.x.

DOI:10.1111/j.1463-1318.2009.02123.x

PMID:19906058

Abstract

AIM

The aim of this study was to analyse the outcome of laparoscopic management of large bowel obstruction (LBO).

METHOD

A prospective electronic database (April 2001-June 2009) was used to identify outcomes in consecutive patients presenting with LBO.

RESULTS

Twenty-four patients (13 male) median age 68 years (range 56-92 years), ASA grade I (2), II (6), III (14) and IV (2), underwent surgery for LBO secondary to cancer (21) and diverticulosis (3). Supervised trainees performed four operations. Operations included anterior resection (10), Hartmann's resection (6), right/extended hemicolectomy (7) and colectomy with ileorectal anastomosis (1). The median operating time was 100 min (range 65-180 min). There were two (8%) conversions. The median time to normal diet was 24 h (range 2-192 h) and median hospital stay 3 days (range 1-30 days). Complications, seen in six patients, included atrial fibrillation (2), wound infection (2), ileus (2), CO(2) retention (1), stoma necrosis (1), circulatory collapse/bowel ischaemia (1) and anastomotic leak (1). There was one (4%) readmission and two (8%) returns to theatre. One patient died.

CONCLUSION

Laparoscopic resectional surgery in acute LBO is feasible and safe with a low complication rate that enables early hospital discharge.

摘要

目的

本研究旨在分析腹腔镜治疗大肠梗阻（LBO）的结果。

方法

使用前瞻性电子数据库（2001 年 4 月至 2009 年 6 月），连续分析因 LBO 就诊的患者的结局。

结果

24 例患者（男 13 例），中位年龄 68 岁（范围 56-92 岁），ASA 分级Ⅰ（2 例）、Ⅱ（6 例）、Ⅲ（14 例）和Ⅳ（2 例），因癌症（21 例）和憩室炎（3 例）导致 LBO 而接受手术。受训者在监督下进行了 4 例手术。手术包括前切除术（10 例）、Hartmann 切除术（6 例）、右/扩大半结肠切除术（7 例）和结肠切除术伴回肠直肠吻合术（1 例）。中位手术时间为 100 分钟（范围 65-180 分钟）。有 2 例（8%）中转开腹。恢复正常饮食的中位时间为 24 小时（范围 2-192 小时），中位住院时间为 3 天（范围 1-30 天）。6 例患者出现并发症，包括心房颤动（2 例）、伤口感染（2 例）、肠梗阻（2 例）、CO2 潴留（1 例）、造口坏死（1 例）、循环衰竭/肠缺血（1 例）和吻合口漏（1 例）。有 1 例（4%）再入院，2 例（8%）再次手术。1 例患者死亡。