腹腔镜探查对腹部疑难疾病的诊治价值

Laparoscopic exploration for the diagnosis and treatment of abdominal complicated diseases

目的探讨和评价腹腔镜探查在腹部疑难疾病诊治中的临床价值。方法回顾分析接受腹腔镜探查术的64例腹部疑难疾病患者的临床资料。腹部疑难疾病患者的纳入标准为临床诊断困难，具有腹痛、腹水、腹部包块、肠梗阻或小肠出血的一种或多种表现。结果64例患者腹腔镜探查后病理确诊62例，确诊率96．9％，其中对腹水、腹部包块、肠梗阻和小肠出血的确诊率分别为93．3％（28／30）、100．0％（13／13）、100．0％（16／16）和6／6。腹腔镜探查术中发生并发症1．6％（1／64）。该组患者中14例（主要为肠梗阻和小肠出血者）在腹腔镜探查术中同时进行治疗性手术，其中8例完成腹腔镜下手术，6例中转开腹完成手术治疗，术后无并发症。结论腹腔镜探查诊治腹部疑难疾病安全、有效，具有较高的临床应用价值。

Objective To evaluate the clinic application effects of laparoscopy in the diagnosis and treatment of abdominal difficult and complicated diseases. Methods The clinical data of 64 cases of agno-genic abdominal diseases underwent laparoscopic exploration and biopsies were retrospectively analyzed. All the patients were difficult cases to diagnose, who have one or more clinical situations, such as abdominal pain, ascites of unknown origin, abdominal mass and intestinal obstruction, and obscure hemorrhage of small intestine. Results Definite diagnosis was made in 62 patients after laparoscopy （96. 9% ）. In patients with ascites, abdominal mass, intestinal obstruction and hemorrhage of small intestine, the definite diagnostic rate were 93.3%, 100. 0%, 100. 0% and 6/6, respectively. The complication rate of laparoscopic exploration was 1.6% （1/64）. Underwent laparoscopic exploration, 14 of 64 cases （22%） were treated by operation. Among them, 8 cases （8/14） were treated by therapeutic laparoscopy, and other 6 cases （6/14） were trea-ted by abdominal surgery without any comliactions. Conclusion Laparoscopic exploration is safe and effec- tive in diagnosis and treatment of abdominal difficult and complicated diseases.