腹腔镜手术在腹茧症治疗中的安全性及可行性研究

doi:10.3877/cma.j.issn.1674-6899.2020.01.008

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (01) : 31 -35. doi: 10.3877/cma.j.issn.1674-6899.2020.01.008

所属专题：文献；

论著

腹腔镜手术在腹茧症治疗中的安全性及可行性研究

段衍涛¹, 黄雨桦¹, 刘斌¹, 姚丹华¹, 郑磊¹, 周致圆¹, 王鹏飞¹, 李幼生¹^,^†(

)

^1. 200011　上海交通大学医学院附属第九人民医院普外科

收稿日期:2019-12-10 出版日期:2020-02-28
通信作者: 李幼生
基金资助:
国家自然科学基金(81802303); 浦东新区卫生和计划生育委员会卫生计生科研项目(PW2018D-01); 白求恩·爱惜康卓越外科基金(HZB-20181119-9)

Safety and feasibility of laparoscopic surgery in the treatment of abdominal cocoon syndrome

Yantao Duan¹, Yuhua Huang¹, Bin Liu¹, Danhua Yao¹, Lei Zheng¹, Zhiyuan Zhou¹, Pengfei Wang¹, yousheng Li¹^,^†()

^1. Department of General Surgery, Shanghai Ninth People′s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China

Received:2019-12-10 Published:2020-02-28
Corresponding author: yousheng Li
About author:
Corresponding author: Li Yousheng, Email: gisurgery@qq.com

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目的

探讨腹腔镜手术在腹茧症治疗中的安全性和有效性。

方法

回顾性分析2016年1月至2019年11月期间在上海交通大学医学院附属第九人民医院就诊共计13例接受外科手术的腹茧症患者的临床资料。

结果

13例患者的外科手术均顺利完成，其中8例腹腔镜手术、5例传统手术。所有患者因肠梗阻症状而就诊，均进行茧膜切除及肠粘连松解术。由于既往腹部手术史，5例采用传统手术方式。相较于传统手术，腹腔镜手术组的术中出血量减少[(116.3 ± 14.0)ml比(180.6 ± 24.9)ml，P< 0.05]，手术时间缩短[(99.3 ± 8.7)min比(130.6 ± 7.5)min，P<0.05]。腹腔镜组与传统手术组分别出现4例、3例术后并发症(P> 0.05)；术后肠梗阻分别3例、2例(P>0.05)；术后住院时间(11.4 ± 3.5)d和(13.4 ± 5.2)d(P> 0.05)。13例患者术后病理均提示纤维性包膜。

结论

腹腔镜手术对于既往无腹部手术史腹茧症治疗是安全、有效的。

关键词: 腹茧症, 腹腔镜手术, 剖腹探查术, 肠梗阻, 并发症

Objective

To analyze the safety and feasibility of laparoscopic surgery in the treatment of abdominal cocoon syndrome.

Methods

A retrospective analysis was performed on the clinical data of 13 patients with abdominal cocoon syndrome who underwent surgery at the department of general surgery in Shanghai Ninth People′s Hospital, Shanghai Jiaotong University School of Medicine from Jan. 2016 to Nov. 2019.

Results

13 patients successfully underwent the surgical treatment. 8 patients underwent laparoscopic surgery, and the other 5 patients were performed with conventional laparotomy. All the patients presented with clinical features of intestinal obstruction, and underwent membrane excision and enterodialysis to release the small intestine. Because of abdominal surgery history, 5 cases were finally approached by laparotomy. Laparoscopic surgery showed less blood loss [(116.3 ± 14.0 ) ml vs (180.6 ± 24.9) ml, P< 0.05] and shorter operative time [(99.3 ± 8.7) min vs (130.6 ± 7.5) ml, P< 0.05] compared with laparotomy. There were 4 cases and 3 cases with postoperative complications (P> 0.05), 3 cases and 2 cases with prolonged ileus (P> 0.05) in the laparoscopic group and the laparotomy group, respectively. The postoperative hospital stay was (11.4 ± 3.5) d and (13.4 ± 5.2) d (P> 0.05) of the laparoscopic and laparotomy group, respectively. The postoperative pathology of 13 patients showed fibrous envelope.

Conclusions

Laparoscopic surgery is a feasible and effective management in the treatment of abdominal cocoon syndrome without abdominal surgery history.

Key words: Abdominal cocoon syndrome, Laparoscopic surgery, Laparotomy, Intestinal obstruction, Complications

图1 腹茧症患者术前增强CT检查

表1 两组腹茧症患者的术前临床资料比较

组别	例数	性别(例，男/女)	年龄(岁，±s)	体质量指数(kg/m²，±s)
腹腔镜手术组	8	6/2	42.6 ± 4.6	18.7 ± 0.6
传统剖腹探查术组	5	3/2	44.2 ± 7.0	19.0 ± 0.7
P值	?	> 0.05	> 0.05	> 0.05

表1 两组腹茧症患者的术前临床资料比较

组别	例数	性别(例，男/女)	年龄(岁，±s)	体质量指数(kg/m²，±s)
腹腔镜手术组	8	6/2	42.6 ± 4.6	18.7 ± 0.6
传统剖腹探查术组	5	3/2	44.2 ± 7.0	19.0 ± 0.7
P值	?	> 0.05	> 0.05	> 0.05

图2 腹腔镜手术的术中情况

表2 两组腹茧症患者的术中临床资料比较(±s)

组别	例数	术中出血量(ml)	手术时间(min)
腹腔镜手术组	8	116.3 ± 14.0	99.3 ± 8.7
传统剖腹探查术组	5	180.6 ± 24.9	130.6 ± 7.5
P值	?	< 0.05	< 0.05

表2 两组腹茧症患者的术中临床资料比较(±s)

组别	例数	术中出血量(ml)	手术时间(min)
腹腔镜手术组	8	116.3 ± 14.0	99.3 ± 8.7
传统剖腹探查术组	5	180.6 ± 24.9	130.6 ± 7.5
P值	?	< 0.05	< 0.05

图3 剥离茧膜病理图片(HE染色，200倍)

表3 两组腹茧症患者的术后临床资料比较

组别	例数	并发症(例，有/无)	术后肠梗阻(例，有/无)	住院时间(d，±s)
腹腔镜手术组	8	4/4	3/5	11.4 ± 3.5
传统剖腹探查术组	5	3/2	2/3	13.4 ± 5.2
P值	?	> 0.05	> 0.05	> 0.05

表3 两组腹茧症患者的术后临床资料比较

组别	例数	并发症(例，有/无)	术后肠梗阻(例，有/无)	住院时间(d，±s)
腹腔镜手术组	8	4/4	3/5	11.4 ± 3.5
传统剖腹探查术组	5	3/2	2/3	13.4 ± 5.2
P值	?	> 0.05	> 0.05	> 0.05

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Safety and feasibility of laparoscopic surgery in the treatment of abdominal cocoon syndrome

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