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入路。手术过程中出现的并发症有：1)使用抓肠钳的肠挫裂伤和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道抓持力，旨在使手边的钳子调节手柄的压力不超过一定的压力，从而防止肠壁的挫伤或超牵引。对于建立腹腔镜粘连松解术最重要的2)的解决方案，我们从其临床结果中对其解决方案进行了检验。我们尝试了17例粘连性肠梗阻的腹腔镜粘连松解术，其中6例在腹腔镜下使用电刀或剪刀，而不是用抓肠钳成功。电刀或sc…粘连松解术11例报告4例(36.4%)粘连松解术后出现肠穿孔。上述穿孔中的任何一个都需要在粘连松解完成后通过小剖腹手术进行穿孔修补。术后病程顺利，至今未见肠梗阻复发。上述临床结果提示粘连松解术中肠穿孔的发生与夹持钳的使用有很大关系，对肠穿孔采用几厘米小切开可获得较好的手术效果。因此，从实验测量电刀或剪刀对牵引性肠管的影响对建立腹腔镜粘连松解术有少许兴趣的事实来看，实验设计停止了。根据我们使用奥林巴斯公司正在开发的外径3 mm的针式腹腔镜的经验，使用这种针式腹腔镜进行粘连松解术，与标准型腹腔镜相比，不仅操作简单，创伤小，而且有助于提高安全性。较少

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