腹腔镜肠粘连松解术对粘连性肠梗阻患者临床效果及并发症的影响分析

Analysis of Clinical Effect and Complications of Laparoscopic Intestinal Adhesiolysis in Patients with Adhesive Intestinal Obstruction

摘要: 目的：分析粘连性肠梗阻患者应用常规开腹手术、腹腔镜肠粘连松解术治疗的临床病理学特性及预后效果。方法：收集2020年6月至2022年6月期间于青岛大学附属医院急诊普外科接受手术治疗的154例粘连性肠梗阻患者的临床资料，分为腔镜组和开腹组，各77例。比较两组手术相关指标、并发症，并观察手术前后血清指标。结果：腔镜组与开腹组手术疗效差异无统计学意义(P > 0.05)；腔镜组切口直径、手术操作耗时、围术期失血量、术后初次离床时间、术后初次排气时间、总住院天数、视觉模拟法(visual analog scale, VAS)评分、并发症发生率均低于开腹组，差异具有统计学意义(P < 0.05)；术后5 d，与开腹组相比腔镜组前白蛋白、IL-10升高，而降钙素原(PCT)、超敏C反应蛋白(hs-CRP)降低，差异有统计学意义(P < 0.05)。结论：腹腔镜肠粘连松解术切口更小，术后炎症反应更轻，利于预后，具有耗时短、失血少、并发症少、疼痛轻、恢复迅速等优势。

Abstract: Objective: To analyze the clinical pathology characteristics and prognosis of patients with adhesive intestinal obstruction treated with conventional open surgery and laparoscopic intestinal lysis. Methods: From June 2020 to June 2022, 154 consecutive patients with adhesive intestinal obstruction, who were treated in the Emergency General Surgery Department of the Affiliated Hospital of Qingdao University, were divided into two groups: laparoscopic group and Open Group, 77 cases each. The related indexes, complications and serum indexes before and after operation were compared between the two groups. Results: There was no significant difference in surgical efficacy between the laparoscopic group and the open group (P > 0.05). The incision diameter, operation time, intraoperative blood loss, time to first ambulation after surgery, time to first flatus after surgery, total hospital stay, visual analog scale (VAS) score, and complication incidence rate were all lower in the laparoscopic group than in the open group (P < 0.05). On postoperative day 5, prealbumin and IL-10 levels were higher, while procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) levels were lower in the laparoscopic group compared to the open group (P < 0.05). Conclusion: laparoscopic lysis of intestinal adhesion has the advantages of less incision, less inflammatory reaction, shorter time-consuming, less blood loss, fewer complications, less pain and rapid recovery.