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目的探讨腹腔镜在多发伤合并腹部创伤诊治中的价值。方法收集近两年来,本院急诊科为尽早作出诊断并给予确定性治疗而应用腹腔镜技术诊治的31例多发伤合并腹部创伤病例的临床资料,与21例传统剖腹探查病例的临床资料比较,对腹腔镜在腹部创伤诊治中的时效性、诊断率、治疗率、非治疗性手术率等方面进行分析。结果共有31例多发伤合并腹部创伤患者在急诊科接受了腹腔镜手术,均未因临床观察而耗损时间。术前耗时(61·5±9·2)min,比剖腹组(180·5±99·5)min明显缩短(P<0·01);其中28例在腹腔镜下明确诊断(占90·3%),21例在腹腔镜下完成治疗(占67·7%),4例得以明确诊断但不需特别处理(占12·9%),中转开腹6例(占19·4%)。术后肠鸣音恢复时间为(2·2±0·9)d,比剖腹组的(3·1±1·0)d明显缩短(P=0·001)。未发生腹腔镜相关并发症。结论腹腔镜手术对多发伤合并的腹部损伤能及时作出正确诊断并给予确定性治疗,提高抢救时效,加快患者康复。
Objective To investigate the value of laparoscopy in the diagnosis and treatment of multiple trauma and abdominal trauma. Methods The clinical data of 31 cases with multiple trauma and abdominal trauma diagnosed by laparoscopic diagnosis and treatment of emergency department of our hospital in the past two years for early diagnosis and definite treatment were compared with the clinical data of 21 cases of conventional laparotomy. Laparoscopy in the diagnosis and treatment of abdominal trauma timeliness, diagnostic rate, treatment rate, non-therapeutic surgical rate and other aspects were analyzed. Results A total of 31 patients with traumatic multiple trauma and abdominal trauma underwent laparoscopic surgery in the emergency department, without any loss of time due to clinical observation. The preoperative time (61.5 ± 9.2 min) was significantly shorter than that of the laparotomy group (180.5 ± 99.5) min (P <0.01), of which 28 were diagnosed laparoscopically · · · · · · · · · · · · · · · · · · · · ·) · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ··· ······························ ). Postoperative bowel sound recovery time was (2.2 ± 0.9) days, significantly shorter than (3.1 ± 1.0) days in the laparotomy group (P = 0.001). Laparoscopic related complications did not occur. Conclusions Laparoscopic surgery for multiple traumatic injury associated with abdominal injury can make the correct diagnosis in time and give definitive treatment to improve the rescue time and speed up the rehabilitation of patients.