本文關(guān)鍵詞： 腹腔鏡探查 急腹癥 開腹探查術(shù)　出處：《西安醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的追蹤分析臨床急腹癥患者采用不同探查方法治療后的療效,探討腹腔鏡檢查在急腹癥應(yīng)用中的優(yōu)越性,為臨床上處理急腹癥提供準(zhǔn)確詳實(shí)的參考依據(jù)。方法選擇西安高新醫(yī)院2010年6月至2016年6月間的250例急腹癥患者,入組標(biāo)準(zhǔn):急性腹痛入院,查體存在程度不一的腹部壓痛、反跳痛等表現(xiàn),相關(guān)檢查手段未明確診斷(血常規(guī),生化,血淀粉酶,腹平片,腹部B超,腹部CT),除外血流動(dòng)力學(xué)不穩(wěn)定、腹腔內(nèi)大出血、疑有嚴(yán)重復(fù)合傷或腹膜后臟器損傷、術(shù)前經(jīng)非手術(shù)手段已明確診斷者、腹腔鏡術(shù)中改為開腹探查術(shù)者,其中男性患者有146例,女性患者有104例,患者年齡區(qū)間為21~68歲,平均年齡為(45.46±9.35)歲;患者發(fā)病后來院時(shí)間為6~71 h之間;以上250例患者隨機(jī)分為試驗(yàn)組和對(duì)照組,其中試驗(yàn)組140例對(duì)照組110例,試驗(yàn)組采取電子腹腔鏡探查術(shù),對(duì)照組采取剖腹探查術(shù)。以上兩組患者根據(jù)試驗(yàn)要求采用腹腔鏡和開腹探查后觀察2組患者的確診率、手術(shù)切口長(zhǎng)度、手術(shù)出血量、置管率、置管留置時(shí)間、手術(shù)時(shí)間、抗生素使用時(shí)間、術(shù)后腹痛癥狀消失時(shí)間、肛門排氣排便時(shí)間、進(jìn)食時(shí)間、住院時(shí)間差異及其切口感染率,將以上數(shù)據(jù)進(jìn)行分析,證明腹腔鏡探查在急腹癥診治中的優(yōu)勢(shì)。實(shí)驗(yàn)數(shù)據(jù)采用SPSS 18.0軟件進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料采取(?x±s)表示,組間比較采用t檢驗(yàn);計(jì)數(shù)資料均用n/%表示,組間采用χ2檢驗(yàn)進(jìn)行比較。P0.05代表差異具統(tǒng)計(jì)學(xué)意義。結(jié)果250例急腹癥患者,包括:急性闌尾炎和慢性闌尾炎急性發(fā)作122例(48.8%),胃十二指腸潰瘍穿孔43例(17.2%),急性結(jié)石性膽囊炎和慢性結(jié)石性膽囊炎急性發(fā)作67例(26.8%),粘連性腸梗阻18例(7.2%)。試驗(yàn)組140例均于腹腔鏡探查下明確診斷并于腔鏡下完成手術(shù),無1例死亡病例;對(duì)照組110例均行傳統(tǒng)剖腹探查術(shù),兩組患者確診率的差異無統(tǒng)計(jì)學(xué)意義(P0.05),但手術(shù)切口長(zhǎng)度、手術(shù)出血量、置管率、置管時(shí)間、手術(shù)時(shí)間、抗生素使用時(shí)間、術(shù)后腹痛消失時(shí)間、肛門排氣排便時(shí)間、進(jìn)食時(shí)間、住院時(shí)間及切口感染率的差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論(1)腹腔鏡技術(shù)應(yīng)用于急腹癥探查,能及早明確診斷,且能避免不必要的開腹手術(shù),從而避免病情的延誤,改善患者預(yù)后;(2)急腹癥患者應(yīng)用腹腔鏡技術(shù)進(jìn)行探查手術(shù),可將診斷、治療同步進(jìn)行,兼具診斷與治療的雙重作用;(3)腹腔鏡探查在急腹癥診治中可充分發(fā)揮腹腔鏡視野開闊的特點(diǎn),在直視下進(jìn)行操作,有利于徹底沖洗腹腔內(nèi)膿液、血液、膽汁及腸內(nèi)容物,再在各腔隙陷窩放置引流后,有助于減少術(shù)后感染和腸粘連的發(fā)生;(4)腹腔鏡探查應(yīng)用于急腹癥診治造成的傷口小,腹腔鏡下操作對(duì)于腹腔內(nèi)組織的干擾較小,對(duì)組織器官損傷較輕,術(shù)后較少發(fā)生腸粘連,患者術(shù)后胃腸道功能很快得以恢復(fù),減少了住院時(shí)間。
[Abstract]:Objective to analyze the curative effect of different exploration methods in patients with acute abdomen and discuss the superiority of laparoscopy in the application of acute abdomen. Methods 250 patients with acute abdomen were selected from June 2010 to June 2016 in Xi'an High Tech Hospital and admitted to hospital with acute abdominal pain. Physical examination of varying degrees of abdominal tenderness, rebound pain and other manifestations, the relevant examination methods are not clear diagnosis (blood routine, biochemical, blood amylase, abdominal plain film, abdominal B ultrasound, abdominal CTT). Except hemodynamic instability, intraperitoneal hemorrhage, suspected serious complex injury or retroperitoneal organ injury, preoperative non-operative means have been clearly diagnosed, laparoscopic surgery instead of laparotomy exploration. There were 146 male patients and 104 female patients. The age range of the patients was 21 68.The average age was 45.46 鹵9.35 years. The time of the patient coming to hospital after onset was between 61h and 71h. The above 250 patients were randomly divided into the experimental group and the control group, of which 140 cases in the experimental group and 110 cases in the control group. In the control group, laparoscopy and laparotomy were used to observe the diagnosis rate, incision length, bleeding volume, catheterization rate and indwelling time after laparoscopy and laparotomy. Operation time, antibiotic use time, postoperative abdominal pain symptom disappearance time, anal exhaust defecation time, feeding time, hospitalization time and incision infection rate were analyzed. To prove the advantage of laparoscopic exploration in the diagnosis and treatment of acute abdomen. The experimental data were analyzed by SPSS 18.0 software. X 鹵s), t test was used for comparison between groups. Counting data were expressed as n /%, 蠂 2 test was used between the two groups to compare. P05 was statistically significant. Results 250 patients with acute abdomen. These included acute appendicitis and chronic appendicitis in 122 patients with acute appendicitis (48.8%) and perforation of gastroduodenal ulcer (43 cases). Acute gallstone cholecystitis and chronic calculous cholecystitis in 67 patients with acute attack. There were 18 cases of adhesive intestinal obstruction. 140 cases of experimental group were definitely diagnosed by laparoscopy and operated under laparoscope, none of them died. There was no significant difference in the diagnosis rate between the two groups (P 0.05), but the length of incision, the amount of bleeding, the rate of catheterization, the time of catheterization and the time of operation. Time of antibiotic use, time of disappearance of abdominal pain after operation, time of anal exhaust and defecation, time of eating. The difference of hospitalization time and incision infection rate was statistically significant (P 0.05) conclusion Laparoscopic technique can be used in the exploration of acute abdomen, can be diagnosed as early as possible, and can avoid unnecessary open surgery. In order to avoid the delay of the disease and improve the prognosis of patients; (2) Laparoscopic technique is used to explore the patients with acute abdomen. The diagnosis and treatment can be carried out simultaneously, which has the dual function of diagnosis and treatment. Laparoscopic exploration in the diagnosis and treatment of acute abdomen can give full play to the characteristics of open laparoscopic visual field, under the direct vision of the operation, is conducive to the thorough washing of abdominal pus, blood, bile and intestinal contents. After drainage was placed in the lacunar lacunae, it was helpful to reduce postoperative infection and intestinal adhesion. 4) Laparoscopic exploration was used in diagnosis and treatment of acute abdomen, the wound caused by laparoscopy was small, the operation under laparoscope had less interference to abdominal tissue, less injury to tissues and organs, and less intestinal adhesion after operation. Postoperative gastrointestinal function recovered quickly, reducing hospital stay.
【學(xué)位授予單位】：西安醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R656.1

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