【摘要】 目的：探讨有开腹手术史的患者行腹腔镜胃肠手术的可行性与技巧。方法：回顾分析8例有开腹手术史的患者再次行腹腔镜胃肠手术的临床资料。结果：除1例患者因腹腔广泛粘连中转开腹手术外，其余患者均在腹腔镜下完成粘连松解及相应的胃肠手术，无手术并发症发生。结论：有腹部手术史的患者仍可行腹腔镜胃肠手术，但应做好术前评估及中转开腹的准备
【关键词】 胃肠外科手术；肠粘连；腹腔镜术
The experience and skills of laparoscopic gastroenteric surgery for patients with previous laparotomy QIAN Jun,TANG Liming,ZHU Jie,et al.Dept.of Gastrointestinal Surgery,the Second People s Hospital of Changzhou,Nanjing Medical University,Changzhou 213003,China
【Abstract】 Ｏbjective:To discuss the feasibility and skills of laparoscopic gastroenteric surgery for patients who had a previous history of laparotomy.Methods:Laparoscopic gastroenteric operations were performed in eight cases who had a previous history of laparotomy from Jan.2008 to Oct.2008,and the data were analyzed and followed up.Results:The lysis of intestinal adhesion and gastroenteric operations were successfully performed under laparoscopy in seven cases,one case was converted to open surgery because of widely tight adhesion.No postoperative complications occurred.Conclusions:People who had a previous laparotomy still have an opportunity to undertake laparoscopic gastroenteric surgery,but the feasibility should be estimated before operation and the surgeon should have preparation of converting to open surgery.
【Key words】 Gastrointestinal surgical procedures;Intestinal adhesion;Laparoscopy
腹部外科手术后约90%的患者会发生肠粘连［1］，腹腔镜开展早期，此类患者属手术禁忌证。随着腹腔镜技术的普及和临床经验的积累，腹腔镜手术适应证逐步扩大。我院2008年1月至11月已为50余例患者行腹腔镜胃肠手术，其中8例有开腹手术史，7例患者最终顺利完成腹腔镜胃肠手术，效果满意，现报道如下。
1 资料与方法
1.1 临床资料 本组8例患者中男3例，女5例，46～72岁，平均54.3岁。既往手术病种：阑尾切除术1例，子宫次全切除术2例，胆囊切除术2例，一侧附件切除术1例，十二指肠球部溃疡穿孔修补术1例，外伤性肠破裂修补术1例。上次手术时间距此次入院时间8个月～10年，均无肠梗阻发作史。
1.2 方法
1.2.1 手术方式 本次行腹腔
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