Poves Ignasi, Sebastián Valverde Enric, Puig Companyó Sònia, Dorcaratto Dimitri, Membrilla Estela, Pons María José, Grande Luís
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
Cir Esp. 2014 May;92(5):336-40. doi: 10.1016/j.ciresp.2013.05.008. Epub 2013 Sep 12.
Laparotomy is the standard approach for the surgical treatment of acute small bowel obstruction (ASBO).
From February 2007 to May 2012 we prospectively recorded all patients operated by laparoscopy in our hospital because of ASBO due to adhesions (27 cases) and/or internal hernia (6 cases). A preoperative abdominal CT was performed in all cases. Patients suffering from peritonitis and/or sepsis were excluded from the laparoscopic approach. It was decided to convert to laparotomy if intestinal resection was required.
The mean age of the 33 patients who underwent surgery was 61.1 ± 17.6 years. 64% had previous history of abdominal surgery. 72% of the cases were operated by surgeons highly skilled in laparoscopy. Conversion rate was 21%. Operative time and postoperative length of stay were 83 ± 44 min. and 7.8 ± 11.2 days, respectively. Operative time (72 ± 30 vs 123 ± 63 min.), tolerance to oral intake (1.8 ± 0.9 vs 5.7 ± 3.3 days) and length of postoperative stay (4.7 ± 2.5 vs 19.4 ± 21 days) were significantly lower in the laparoscopy group compared with the conversion group, although converted patients had greater clinical severity (2 bowel resections). There were two severe complications (Clavien-Dindo III and V) in the conversion group.
In selected cases of ASBO caused by adhesions and internal hernias and when performed by surgeons highly skilled in laparoscopy, a laparoscopic approach has a high probability of success (low conversion rate, short hospital length of stay and low morbidity); its use would be fully justified in these cases.
剖腹手术是急性小肠梗阻（ASBO）外科治疗的标准方法。
2007年2月至2012年5月，我们前瞻性记录了我院因粘连性（27例）和/或内疝（6例）导致的ASBO而接受腹腔镜手术的所有患者。所有病例均进行了术前腹部CT检查。患有腹膜炎和/或脓毒症的患者被排除在腹腔镜手术之外。如果需要进行肠切除，则决定转为剖腹手术。
接受手术的33例患者的平均年龄为61.1±17.6岁。64%有腹部手术史。72%的病例由腹腔镜技术高超的外科医生进行手术。转换率为21%。手术时间和术后住院时间分别为83±44分钟和7.8±11.2天。与转换组相比，腹腔镜组的手术时间（72±30 vs 123±63分钟）、口服耐受性（1.8±0.9 vs 5.7±3.3天）和术后住院时间（4.7±2.5 vs 19.4±21天）显著缩短，尽管转换组患者的临床病情更严重（2例肠切除）。转换组有2例严重并发症（Clavien-Dindo III和V级）。
在由粘连和内疝引起的ASBO的特定病例中，当由腹腔镜技术高超的外科医生进行手术时，腹腔镜手术有很高的成功概率（低转换率、短住院时间和低发病率）；在这些病例中使用腹腔镜手术是完全合理的。
