目的探讨腹腔镜在腹部外伤并胃肠道损伤中的诊治作用。 方法对我院2005年1月至2010年6月期间60例行腹腔镜手术治疗的腹部外伤并胃肠道损伤患者的临床资料，以及腹腔镜手术入路及术中处理情况进行回顾性分析。 结果60例患者均经腹腔镜手术证实为胃肠道损伤，根据损伤的具体情况，行完全腹腔镜手术20例、腹腔镜下辅助手术40例，其中行胃肠穿孔修补术45例,肠段切除术15例。 所有患者均顺利完成手术，无术后胃肠道瘘和腹腔出血情况，有2例患者术后出现切口感染，经换药后治愈。 结论 腹腔镜在腹部外伤并胃肠道损伤方面的诊断价值确切，治疗效果满意，避免了不必要的剖腹手术，且创伤小，是一种安全、合理的手术方式。
Objective To analyze the risk factors and prognosis of acute gastrointestinal injury (AGI) early after acute type A aortic dissection (ATAAD) repair, and develop the Nomogram prediction model of AGI. Methods The patients who underwent ATAAD cardiopulmonary bypass surgery in our hospital from 2016 to 2021 were collected and divided into an AGI group and a non-AGI group. The clinical data of the two groups were compared. A Nomogram prediction model was established by using R language. Results A total of 188 patients were enrolled, including 166 males and 22 females, aged 22-70 (49.70±9.96) years. Through multivariate logistic regression analysis, the aortic dissection (AD) risk score, poor perfusion of superior mesenteric artery (SMA), duration of aortic occlusion and intraoperative infusion of red blood cells were the predictors for AGI (P<0.05). There were statistical differences in the ventilator-assisted duration, ICU stay time, liver dysfunction, renal insufficiency, parenteral nutrition, nosocomial infection and death within 30 days after the operation between the two groups (P<0.05). The Nomogram prediction model was established by using the prediction factors, and the C index was 0.888. Through internal verification, the C index was 0.848. The receiver operating characteristic curve was used to evaluate the discrimination of the model, and the area under the curve was 0.888. Conclusion The AD risk score after ATAAD, poor perfusion of SMA, duration of aortic occlusion and intraoperative infusion of red blood cells are independent predictors for AGI. The Nomogram model has good prediction ability.