Yao SiYuan, Tanaka Eiji, Ikeda Atsushi, Murakami Teppei, Okumoto Tatsuo, Harada Takehisa
Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagata-ku, Kobe, 653-0013, Japan.
Surg Today. 2017 Apr;47(4):432-439. doi: 10.1007/s00595-016-1389-2. Epub 2016 Jul 23.
Laparoscopic surgery is emerging as an alternative to open surgery for treating acute small bowel obstruction (SBO). While postoperative adhesion is the most frequent etiology, the optimum treatment for all types of SBO needs to be evaluated.
A retrospective review was performed of 110 consecutive patients who underwent laparoscopic surgery at our institution between 2009 and 2015. The short-term outcomes included perioperative factors, while the long-term outcome included the recurrence rate.
Of the 110 patients, 55 were female. The median age at surgery was 69.5 years. Laparoscopic surgery was completed in 91.8 %. The median operative time was 82 min, median amount of bleeding was 0 ml, and median postoperative hospital stay was 8 days. Intraoperative major organ injury was seen in 2.7 %. The complication rate (Clavien-Dindo ≥ class II) was 8.2 %, and the mortality rate was 3.6 %. The recurrence rate was 8.2 %. Only dense and matted adhesion was a predictive factor for conversion (OR 30.244).
Good short-term outcomes and feasible long-term outcomes were achieved with a laparoscopic approach to treating acute SBO. It was a safe and effective method, especially in patients with isolated bands, simple enteral angulation, and foreign body or tumor, while dense and matted adhesions were still challenging.
腹腔镜手术正逐渐成为治疗急性小肠梗阻（SBO）的开放性手术的替代方法。虽然术后粘连是最常见的病因，但需要评估针对所有类型SBO的最佳治疗方法。
对2009年至2015年间在本机构接受腹腔镜手术的110例连续患者进行回顾性研究。短期结果包括围手术期因素，而长期结果包括复发率。
110例患者中，55例为女性。手术时的中位年龄为69.5岁。91.8%的患者完成了腹腔镜手术。中位手术时间为82分钟，中位出血量为0毫升，中位术后住院时间为8天。术中主要器官损伤发生率为2.7%。并发症发生率（Clavien-Dindo≥Ⅱ级）为8.2%，死亡率为3.6%。复发率为8.2%。只有致密和粘连成团是转为开放性手术的预测因素（比值比30.244）。
采用腹腔镜方法治疗急性SBO可取得良好的短期结果和可行的长期结果。这是一种安全有效的方法, 尤其适用于有孤立束带、单纯肠管成角、异物或肿瘤的患者，而致密和粘连成团的粘连仍然具有挑战性。
