摘要
目的探讨腹腔镜联合术中小肠镜检查对小肠疾病的诊断及治疗价值。方法回顾性分析接受腹腔镜联合小肠镜进行诊断和治疗的69例小肠疾病患者的临床资料。结果69例患者术中腹腔镜检查发现病变48例（69％），未发现病变的21例患者联合术中小肠镜检查后病变均获明确。所有手术均于腹腔镜下顺利完成．其中完全腹腔镜下肠切除吻合术11例，腹腔镜辅助小肠部分切除术58例。术后未出现吻合口瘘、术后出血、肠梗阻、切口感染等并发症．所有患者均于术后7-9d痊愈出院。术后病理证实：血管畸形10例，胃肠间质瘤20例，小肠腺癌5例，小肠神经纤维瘤2例，憩室5例，小肠黏膜溃疡8例，肠结核3例，小肠术后储袋出血1例，小肠息肉6例．克罗恩病5例，Meckel憩室2例，肾癌小肠转移癌1例，肺癌小肠转移癌1例。经3个月至4年的随访，未见再次出血；2例胃肠间质瘤患者因局部复发伴肝转移而死亡；1例腺癌患者因局部复发伴胰头、十二指肠、肠系膜血管浸润死亡；2例转移癌患者因腹腔复发及肝转移死亡。结论腹腔镜联合术中小肠镜对小肠疾病的检出率高、定位准确、创伤小、恢复快。
Objective To evaluate the value of laparoscopy combined with double-balloon enteroscopy （DBE） for the diagnosis and treatment of intestinal diseases. Methods Clinical data of 69 cases with suspected small bowel diseases undergoing laparoscopic and DBE for the diagnosis and treatment were retrospectively analyzed. Results The lesions were found in 48 cases by laparoscopy. DBE was required in the remaining 21 patients to identify the underlying condition. All the operations were successfully completed using the laparoscopic approach, including totally laparoscopic bowel resection（n=11 ）, and laparoscopic-assisted bowel resection （n=58）. There were no anastomotic leakage, postoperative bleeding, intestinal obstruction, or wound infection. All the patients were discharged within 7 to 9 days after surgery. Postoperative pathological examination showed vascular abnormally （n = 10）, gastrointestinal stromal tumor （n =20）, intestinal adenocarcinoma （n =5）, intestinal neurofibroma （n =2）, diverticulum （n =5）, intestinal mucosal ulceration （n =8）, intestinal tuberculosis （n =3）, postoperative pouch bleeding （n=1）, intestinal polyp （n=6）, Crohn＇s disease （n=5）, Meckel diverticulum （n=2）, metastatic kidney cancer （n=1）, and metastatic lung cancer （n=1）. Length of follow up ranged from 3 months to 4 years, during which no re-bleeding occurred, 2 patients with gastrointestinal stromal tumor died of local recurrence and liver metastasis, 1 patient with adenocarcinoma died of local recurrence involving pancreatic head, duodenum, and mesenteric vessels, 2 patients with metastatic disease died of peritoneal recurrence and liver metastasis. Conclusion Laparoscopic combined with DBE has a high detection rate for small intestinal disease with accurate localization, less trauma, and quicker recovery.
出处
《中华胃肠外科杂志》
CAS
北大核心
2011年第12期952-954,共3页
Chinese Journal of Gastrointestinal Surgery
基金
重庆市自然科学基金（2009BB5017）
关键词
腹腔镜
双气囊小肠镜
小肠疾病
Laparoscopy
Double-balloon enteroscopy
Small bowel disease
作者简介
通信作者：杨桦，Email：hwbyang@126．com
