腹腔镜在急腹症和腹部外伤诊治中的体会

Laparoscopic diagnosis and treatment of in patients with acute abdomen and abdominal trauma

目的:探讨应用腹腔镜诊断和治疗外科急腹症及腹部外伤的价值。方法:回顾分析腹腔镜在58例外科急腹症和腹部外伤应用中的临床资料。结果:58例中有27例在不明确病因的情况下由腹腔镜得到确诊,确诊率为100%,其中24例在腹腔镜下治疗,3例中转开腹;31例病例在已明确病因下用腹腔镜治疗,内2例胃十二指肠溃疡穿孔术后出现腹腔脓肿。31例中有3例死亡,其中1例胃穿孔因延误了手术时机而死于感染性休克,2例死于急性重症胰腺炎并发症,其余均痊愈出院,治疗成功率为90.3%。结论:腹腔镜技术在外科急腹症诊断及治疗中具有独特的优势,既可明确诊断,又能同时进行治疗,且有良好的临床应用价值。

Objective To evaluate the effect of laparoscopic dmanagement of patients with acute abdomen and abdominal trauma. Methods The clinical data of 58 cases of acute abdomen and abdominal trauma were studied respectively. Results Twenty-seven cases of uncertain etiology reason were successfully diagnosed by laparoscopy,with a diagnosis rate of 100%; 24 cases of operated upon by laparoscopy, and 3 cases treated by open surgery. Twenty-eight of 31 cases (90.3%) with a certain pre-operative diagnosis were successfully treated by laparoscopy; 2 cases with gastric and duodenal perforation were complicated by abdominal abscess after laparoscopic repair. Three of the 31 cases were dead, 1 died of septic shock with a delayed diagnosis of gastric perforation, and 2 died of complicated acute severe pancreatitis. Conclusion There exists a particular advantage in the diagnosis and treatment of surgical acute abdomen by laparoscopy. The method can be applied successfully clinically.