摘要
目的：总结４７例急腹症微型腹腔镜手术的治疗效果。方法：对１９９６～１９９８年应用微型腹腔镜诊治的４７例原因不明的急腹症做回顾总结。术式选择由值班医师决定。弥漫性腹膜炎和有手术史者除外。结果：４４例通过微型腹腔镜明确诊断（９３ ．６％），３３例在微型腹腔镜下治愈（７０． ２％），微型腹腔镜对急性盆腔炎的诊断率和治疗率为 １００％。对急性阑尾炎的诊断率和治疗率为８６．７％和５３．１％。 ４５例治疗性微型腹腔镜术中有１０例中转为传统腹腔镜手术（中转率２２．２％），２例中转为开腹手术（４．４％）。中转因素主要为视野障碍和微型器械解剖困难。死亡率为零，无与伤口有关的并发症，无需镇痛剂。１例术后并发症为盆腔残余脓肿（保守治疗痊愈）。平均手术时间 ３４ ｍｉｎ。平均住院天数 ６ ．８ ｄ。结论：只要合理使用，严格掌握适应证，微型腹腔镜诊治急腹症可取得良好效果。
Objective: To summarize the microlaparoscopic surgery in the patients with abdominal emergencies. Methods: From 1996 to 1998, 47 patients operated by microlaparoscopy for acute abdomen of unknown causes were analyzed retrospectively. The way to treat the patients by microlaparoscopy was decided by the surgeon on duty. Patients with general peritonitis and operative history were excluded in this study. Results: Microlaparoscopy provided a definitive diagnosis in 44 cases (93. 6 % ), 33 cases (70. 2 % ) were treated exclusively by microlaparoscopy. The correct diagnostic rate and therapeutic rate were 100 % in acute pelvic inflammation, 86. 7 % and 53. 1 % respectively in acute appendicitis. 10 of 45 cases in operative microlaparoscopy required conversion to the conventional laparoscopy (22. 2 % ), and 2 cases required open operation (4. 4 % ). The main causes of conversrion were limited optic image and difficult dissection by microinstruments. There was no mortality, no was of antalgic, no complications of the wound. One postoperative complication was pelvic abscess (treated conservatively with drainae). The average operative time was 34 minutes. The average postoperative stay was 6. 8 days. Conclusion: Under appropriate indication, the microlaparoscopy could be performed for abdominal emergencies with excellent results.
