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摘要: 目的 对比分析腹腔镜手术和开腹手术治疗外伤直肠破裂的疗效。方法 回顾性总结我院2015年1月1日—2022年6月20日收治的外伤直肠破裂患者共54例，其中49例行手术治疗，18例行腹腔镜手术(腹腔镜组)，31例行开腹手术(开腹组)。对比2组患者手术情况、术后一般情况、住院总费用和术后并发症的发生率。结果 腹腔镜组的手术时间、术中出血量、住院时间及术后疼痛评分均显著小于开腹组，差异有统计学意义(P < 0.05)。腹腔镜组术后并发症发生率为38.9%，开腹组为55.1%，腹腔镜组出现并发症的例数较开腹组少，但差异无统计学意义。结论 及时正确的诊断和早期有效手术对治疗直肠破裂至关重要；腹腔镜手术治疗外伤直肠破裂创伤小，探查全面，手术时间短，术后恢复快，并发症发生率低，且费用方面与开腹手术相差不大，适合临床推广应用。Abstract: Objective To compare the efficacy of laparoscopic surgery and open surgery in the treatment of traumatic rectal rupture.Methods A total of 54 patients with traumatic rectal rupture in our hospital from January 1st 2015 to June 20th 2022 were selected, 49 of whom underwent surgical treatment. Eighteen patients underwent laparoscopic surgery(laparoscopic group), and 31 patients underwent open surgery(open group). The operation conditions, postoperative general conditions, total hospitalization costs and incidence of postoperative complications were compared between the two groups.Results The operation time, intraoperative blood loss, hospital stay, and postoperative pain score of the laparoscopic group were significantly lower than those of the open group(P < 0.05). The incidence of postoperative complications was 38.9% in the laparoscopic group and 55.1% in the open group. The number of complications in the laparoscopic group was less than that in the open group, but there was no significant statistical difference.Conclusion Correct diagnosis and early effective surgery is crucial for the treatment of rectal rupture. Laparoscopic surgery for traumatic rectal rupture has the advantages of less trauma, comprehensive exploration, short operation time, quick postoperative recovery and low complication rate. And there is no significant difference in cost between laparoscopic surgery and open surgery, the use of laparoscopic technology in the treatment of traumatic rectal rupture is worthy of clinical application.
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Key words:
- laparoscopic surgery /
- minimally invasive /
- traumatic rectal rupture /
- traumatism
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表 1 2组患者手术与术后一般情况比较
X±S 组别 例数 手术时间/min 术中出血量/mL 术后排气时间/d 住院时间/d 住院总费用/元 术后疼痛评分/分 腹腔镜组 18 145.44±24.31 43.06±25.85 2.61±0.85 11.33±2.14 63 365.43±9516.85 2.72±1.02 开腹组 31 219.19±61.54 92.90±84.47 3.19±1.28 16.74±7.71 60 758.58±10 237.32 4.87±1.23 t 4.85 2.43 1.91 2.90 0.89 6.25 P 0.00 0.02 0.06 0.01 0.37 0.00 
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表 2 2组患者直肠损伤部位比较
例(%) 损伤部位 腹腔镜组(n=18) 开腹组(n=31) 腹膜反折以上 7(38.9) 12(38.7) 腹膜反折以下 11(61.1) 19(61.3)
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表 3 2组患者术后并发症比较
例(%) 并发症 腹腔镜组(n=18) 开腹组(n=31) χ2 P 切口感染 1(5.6) 5(16.1) 1.18 0.27 切口裂开 0 3(9.7) 1.85 0.24 肠梗阻 1(5.6) 2(6.5) 0.02 0.69 吻合口瘘 1(5.6) 1(3.2) 0.16 0.61 肺部感染 1(5.6) 1(3.2) 0.16 0.61 术后出血 1(5.6) 1(3.2) 0.16 0.61 二次手术 0 2(6.5) 1.21 0.39 腹腔感染 1(5.6) 3(9.7) 0.26 0.53 造瘘口并发症 1(5.6) 2(6.5) 0.02 0.69 病死率 0 3(9.7) 1.85 0.24 合计 7(38.9) 20(55.1) 3.029 0.07
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[1] 张连阳. 损害控制时代的结直肠损伤手术变迁[J]. 中华急诊医学杂志, 2018, 27(5): 465-468. doi: 10.3760/cma.j.issn.1671-0282.2018.05.001
[2] Dulskas A, Samalavicius NE, Gupta RK, et al. Laparoscopic colorectal surgery for colorectal polyps: single institution experience[J]. Videosurgery Other Miniinvasive Tech, 2015, 10(1): 73-78.
[3] 瞿紫微, 孟庆彬, 李晓辉, 等. 外伤性结直肠穿孔的腹腔镜下结肠造瘘术[J]. 中华普通外科杂志, 2014, 29(2): 140-141. doi: 10.3760/cma.j.issn.1007-631X.2014.02.020
[4] 张启瑜. 钱礼腹部外科学[M]. 北京: 人民卫生出版社, 2006: 451-452.
[5] 于国志, 于洪顺, 陈希琳, 等. 自慰性直肠异物诊治经验(附31例报告)[J]. 结直肠肛门外科, 2019, 25(2): 230-232. https://www.cnki.com.cn/Article/CJFDTOTAL-DCGM201902027.htm
[6] Bots EMT, Hoek RAS. Pneumomediastinum due to traumatic rectal perforation[J]. Am J Respir Crit Care Med, 2020, 201(5): e15-e16. doi: 10.1164/rccm.201902-0276IM
[7] 杨阳, 张春霞, 刘建磊, 等. 非创伤性结直肠穿孔病因分析及治疗体会[J]. 腹部外科, 2020, 33(6): 445-449. doi: 10.3969/j.issn.1003-5591.2020.06.009
[8] 莫家彬, 贾红明, 欧鸿儒, 等. 腹部闭合创伤性小肠、结肠破裂的CT征象分析[J]. 现代医用影像学, 2016, 25(3): 391-393. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYY201603005.htm
[9] 封益飞, 张冬生, 唐俊伟, 等. 结肠镜检查治疗所致结直肠穿孔外科手术治疗的探讨[J]. 国际外科学杂志, 2022, 49(2): 86-90.
[10] 张伟耀, 饶智, 梁志宏, 等. 结肠穿孔(破裂)的早期诊断及治疗[J]. 中国现代普通外科进展, 2014, 17(11): 906-908. https://www.cnki.com.cn/Article/CJFDTOTAL-PWJZ201411021.htm
[11] 曹李, 田靖波, 董光龙. 腹腔镜技术在急诊直肠损伤诊疗中的应用[J]. 中华普外科手术学杂志(电子版), 2019, 13(3): 253-255. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHPW201903013.htm
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| 引用本文: |
刘颖涵, 关国欣, 柳兴铭, 等. 外伤性直肠破裂的微创治疗[J]. 临床急诊杂志, 2022, 23(12): 812-815. doi: 10.13201/j.issn.1009-5918.2022.12.002
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| Citation: |
LIU Yinghan, GUAN Guoxin, LIU Xingming, et al. Minimally invasive therapy of traumatic rectal rupture[J]. J Clin Emerg, 2022, 23(12): 812-815. doi: 10.13201/j.issn.1009-5918.2022.12.002
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