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。程序上的问题分别是1)肠抓钳引起的肠挫裂伤和2)粘连松解引起的肠损伤。对于1)的解决方案，我们设计了这样一种肠道抓握力，其设计目的是不增加超过一定压力的上述镊子调节手柄的压力，这可以防止肠壁的挫伤撕裂或超牵拉。对于建立腹腔镜粘连溶解术最重要的2)的解决方法，我们从其临床结果探讨其解决方法。迄今为止，我们对17例粘连性肠梗阻进行了腹腔镜粘连松解试验，其中6例在腹腔镜观察下使用电刀或剪刀而非肠钳成功松解。在11例电刀或sc型粘连松解患者中，有4例（36.4%）在肠牵引下出现肠穿孔。任何上述穿孔都需要在完成粘连溶解后通过小剖腹手术进行穿孔修复。到目前为止，所有病例的术后过程良好，无肠梗阻复发。以上临床结果提示粘连溶解下的肠穿孔可能很大程度上归因于肠钳的使用，通过几厘米的小剖腹手术治疗肠穿孔可获得良好的手术效果。因此，由于实验测量电刀或电剪刀对牵拉肠管的影响对建立腹腔镜粘连松解术没有太大的意义，故停止实验设计。结合我们使用Olympus公司正在研发的外径为3mm的针式腹腔镜的经验，我们认为使用这种针式腹腔镜进行腹腔镜粘连松解术，与标准腹腔镜相比，不仅操作简单，创伤小，而且有助于提高安全性。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