CLINICAL AND EXPERIMENTAL STUDY ABOUT THE LAPAROSCOPIC THERAPY FOR ADHESIVE ILEUS

本研究旨在建立腹腔镜粘连松解术治疗粘连性肠梗阻的手术方法。手术问题分别表现为并发症：1）肠夹持钳造成的肠挫伤撕裂和2）粘连松解术造成的肠损伤。对于1）的解决方案，我们设计了这样一种肠夹持力，其被设计成不将上述钳子调节手柄的压力增加到一定压力以上，这使得可以防止肠壁的挫伤撕裂或超牵引。对于2）的解决方案，这是建立腹腔镜粘连松解术最重要的，我们从其临床结果中检查了其解决方案。我们对17例粘连性肠梗阻患者进行了腹腔镜粘连松解术，其中6例在腹腔镜观察下，不用抓肠钳，而用电刀或剪刀成功松解粘连。用电刀或皮下注射法治疗粘连松解术11例， 关于我们 肠粘连松解术出现肠穿孔4例（36.4%）。上述任何一个穿孔都需要在粘连松解术完成后通过小剖腹手术进行穿孔修复。所有病例的术后病程良好，迄今为止未复发肠梗阻。结果表明，粘连松解术中肠穿孔的发生与抓肠钳的使用有很大关系，肠穿孔经几cm小切口手术效果良好。因此，从实验测量电刀或剪刀对小肠管的影响对建立腹腔镜粘连松解术的兴趣不大这一事实判断，停止了实验设计。根据我们使用奥林巴斯公司正在开发的外径为3 mm的针式腹腔镜的经验，有限公司、使用这种针型腹腔镜的腹腔镜粘连松解术被认为与标准型腹腔镜相比，不仅在操作上非常容易并且侵入性更小，而且对于提高安全性也是有用的。少

The present study was made to establish laparoscopic adhesiolysis procedural approach to adhesive ileus. Procedural problems represent complication of 1) intestinal contused laceration with intestinal grasping forceps and 2) intestinal damage on adhensiolysis, each. For the solution of 1), we devised such an intestinal grasping forces as is designed not to increase above a definite pressure the pressure of the above forceps-adjusting handle at hand, and this made it possible to prevent contused laceration or supertraction of the intestinal wall. For the solution of 2), which is most important for establishing the laparoscopie adhensiolysis procedure, we examined its solution approach from its clinical results. We have so far tried the laparoscopie adhensiolysis on 17 cases of adhesive ileus, 6 of which succeeded in adhensiolysis not with intestinal grasping forceps but with electric knife or scissors under laparoscopic observation. Of 11 cases of adhensiolysis with electric knife or sc … More issors under intestinal traction with intestinal grasping forceps, 4 (36.4%) presented intestinal perforations under adhensiolysis. Any one of the above perforations required perforation repair via small laparotomy following the completion of adhensiolysis. The postoperative course was favorable in all cases without recurrence of ileus so far. The above clinical results led to the conclusion that the intestinal perforation under adhensiolysis may be ascribable greatly to the use of intestinal grasping forceps and that good operative results may be obtained through several cm small laparotomy for the intestinal perforation. Therefore, judging from the fact that experimental measurement of the influence of electric knife or scissors on the tracted intestinal canal has a little interest for establishing laparoscopie adhensiolysis procedure, the experimental design was stopped. In view of our experience in using the needle type laparoscopy of 3 mm in extemal diameter now under development by Olympus Co., Ltd., the laparoscopic adhensiolysis using this needle type laparoscopy was thought to be not only very easy procedurally and less invasive compared with standard type laparoscopy, but also useful for the improvement in safety. Less