Wang Jian, Mao Qi, Yao Danhua, Li Yousheng, Li Jieshou
Department of General Surgery, Jinling Hospital, Nanjing Univesity School of Medicine, Nanjing 210002, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Apr;19(4):422-6.
To determine the feasibility and possible superiority of laparoscopic surgery for chronic adhesive small bowel obstruction(CASBO).
Clinical data of 36 CASBO patients who underwent laparoscopic surgery in Jinling Hospital from March 2011 to August 2014 were retrospectively reviewed. In addition, 36 cases, matched by age, gender, previous abdominal surgery history, body mass index(BMI) and abdominal adhesion grade, who underwent open surgery from April 2007 to February 2011 were used as controls. General information, operative findings and short-term outcomes were compared between two groups.
There were no statistically significant differences in baseline data between the two groups (all P>0.05). Among 36 cases in laparoscopic surgery group, 17 underwent complete laparoscopic surgery, 10 underwent laparoscopic assisted surgery and 9 were converted to open surgery, respectively. The conversion rate was 25%(9/36). Reason of laparoscopic assisted surgery in 3 cases was uncertainty of small bowel injury, in 5 cases was further dissection of intra-loop adhesion and in 2 cases was intestinal resection. Reasons for conversion were small bowel injury in 3 cases and severe adbesion at the abdominal wall in 6 cases. There were no differences between two groups in terms of adhesion score, intra-operative blood loss, operation time, need for small bowel resection, total hospital charge and intra- or post-operational complications. As compared to open surgery, laparoscopic surgery significantly shortened the incision length [median 2 (0 to 10) cm vs. 12(7 to 16) cm, P=0.000], and hospital stay [median 5 (2 to 28) days vs. 7 (4 to 26) days, P=0.001], and improved postoperative recovery of bowel movement [median 2(1 to 20) days vs. 3 (2 to 10) days, P=0.001].
Laparoscopic surgery can improve postoperative recovery of CASBO with similar morbidity as open surgery.
确定腹腔镜手术治疗慢性粘连性小肠梗阻（CASBO）的可行性及可能的优势。
回顾性分析2011年3月至2014年8月在金陵医院接受腹腔镜手术的36例CASBO患者的临床资料。另外，选取2007年4月至2011年2月接受开放手术的36例患者作为对照，这些患者在年龄、性别、既往腹部手术史、体重指数（BMI）及腹部粘连分级方面相匹配。比较两组的一般资料、手术所见及短期结局。
两组基线数据差异无统计学意义（均P>0.05）。腹腔镜手术组36例患者中，17例行完全腹腔镜手术，10例行腹腔镜辅助手术，9例中转开放手术，中转率为25%（9/36）。3例腹腔镜辅助手术的原因是小肠损伤情况不明，5例是进一步分离肠袢内粘连，2例是肠切除。中转原因3例为小肠损伤，6例为腹壁严重粘连。两组在粘连评分、术中出血量、手术时间、小肠切除需求、总住院费用及术中或术后并发症方面无差异。与开放手术相比，腹腔镜手术显著缩短了切口长度[中位数2（0至10）cm对12（7至16）cm，P=0.000]、住院时间[中位数5（2至28）天对7（4至26）天，P=0.001]，并改善了术后肠道蠕动恢复情况[中位数2（1至20）天对3（2至10）天，P=0.001]。
腹腔镜手术可改善CASBO患者术后恢复情况，且发病率与开放手术相似。
