Otani Kensuke, Ishihara Soichiro, Nozawa Hiroaki, Kawai Kazushige, Hata Keisuke, Kiyomatsu Tomomichi, Tanaka Toshiaki, Nishikawa Takeshi, Yasuda Koji, Sasaki Kazuhito, Murono Koji, Watanabe Toshiaki
Department of Surgical Oncology, The University of Tokyo, Japan.
Ann Med Surg (Lond). 2017 Mar 1;16:34-39. doi: 10.1016/j.amsu.2017.02.045. eCollection 2017 Apr.
Open laparotomy is widely accepted as the standard surgical treatment for small bowel obstruction (SBO). However, laparoscopic surgery has recently become a treatment option. There is no consensus on the appropriate settings for the laparoscopic treatment of SBO. The purpose of this study is to evaluate the outcomes of laparoscopic surgery for SBO.
From January 2012 to May 2016, 48 consecutive patients underwent surgical treatment for SBO in our department. We retrospectively reviewed these cases and compared the features and the outcomes between laparoscopic and open surgery.
Thirty-four and 14 patients underwent open surgery and laparoscopic surgery, respectively. Four of the laparoscopic cases (28.6%) were converted to open surgery. Laparoscopic surgery tended to be associated with a shorter operative time than open surgery (p = 0.066). The first postoperative oral intake was significantly earlier in patients who underwent laparoscopic surgery (p = 0.044). The duration of hospitalization after surgery and the rates of postoperative complications did not differ to a statistically significant extent. Laparoscopic treatment was accomplished in 7 out of 8 cases (87.5%) with SBO due to band occlusion.
Laparoscopic surgery for SBO is less invasive than open surgery and is equally feasible in selected patients. SBO due to band occlusion may be a preferable indication for laparoscopic surgery. In order to confirm the safety of laparoscopic treatment, and to clarify the appropriate settings for laparoscopic surgery for SBO, it will be necessary to perform further studies in a larger population and with a long follow-up period.
剖腹探查术被广泛认为是治疗小肠梗阻(SBO)的标准手术方式。然而,腹腔镜手术近来已成为一种治疗选择。对于腹腔镜治疗SBO的合适条件尚无共识。本研究的目的是评估腹腔镜手术治疗SBO的效果。
2012年1月至2016年5月,我科连续48例患者接受了SBO手术治疗。我们回顾性分析了这些病例,并比较了腹腔镜手术与开放手术的特点及效果。
分别有34例和14例患者接受了开放手术和腹腔镜手术。4例腹腔镜手术病例(28.6%)中转开腹。腹腔镜手术的手术时间往往比开放手术短(p = 0.066)。接受腹腔镜手术的患者术后首次经口进食明显更早(p = 0.044)。术后住院时间和术后并发症发生率在统计学上无显著差异。8例因束带阻塞导致SBO的病例中有7例(87.5%)成功完成腹腔镜治疗。
腹腔镜手术治疗SBO比开放手术创伤小,在特定患者中同样可行。因束带阻塞导致的SBO可能是腹腔镜手术的较好适应证。为了证实腹腔镜治疗的安全性,并明确SBO腹腔镜手术的合适条件,有必要在更大规模人群中进行进一步研究,并进行长期随访。