微型腹腔镜在急腹症中的应用

The clinical application of microlaparoscope in the diagnosis and management of acute abdomen

目的 探讨微型腹腔镜在急腹症中的应用价值和操作特点。方法 对我院 1996～1998年间应用微型腹腔镜诊治的 47例原因不明的急腹症做回顾性总结。有弥漫性腹膜炎和既往腹部手术史者除外。微型腹腔镜探查、诊断和治疗 ,困难病例则中转为传统腹腔镜手术或开腹手术。结果 44例通过微型腹腔镜明确诊断 (94% ) ,3例中转为传统腹腔镜确诊 ,33例得到治疗 (70 % )。微型腹腔镜对急性盆腔炎的确诊率和治疗率为 10 0 %及 95 %。对急性阑尾炎的确诊率和治疗率为 87%(13/ 15 )和 5 3% (8/ 15 )。 45例 (诊断明确后 2例决定开腹手术 )微型腹腔镜术中有 10例中转传统腹腔镜手术 (中转率 2 2 % ) ,2例转开腹手术 (4 % )。主要为视野障碍和微型器械解剖困难。本组无手术死亡 ,无与伤口有关的并发症。 1例术后并发盆腔残余脓肿。平均手术时间 34min。平均住院 6 8d。结论 微型腹腔镜在急腹症的鉴别诊断中有应用价值 ,其创伤小 ,确诊率高 。

Objective To evaluate the clinical application and characteristics of microlaparoscopic technique in abdominal emergencies. [WT5”HZ]Methods [WT5”BZ] From 1996 to 1998, 47 patients undergoing microlaparoscopy for acute abdomen were analyzed retrospectively. Patients with generalized peritonitis and a history of abdominal surgery were excluded. Once the diagnosis was established, the operative microlaparoscopy was performed, the procedure was converted to conventional laparoscopy or laparotomy if indicated.[WT5”HZ] Results [WT5”BZ] Microlaparoscopy provided a definitive diagnosis in 44 cases (94%), and 33 cases (70%) were treated successfully.The diagnostic and therapeutic accuracy was 100% and 95%, respectively in acute pelvic inflammation, and 87%(13/15) and 53% (8/15)respectively in acute appendicitis. 10 cases were converted to the conventional laparoscopy (22%), and 2 cases required open operation (4%). The major causes of conversion were limited optic image and difficult dissection. There was no mortality, nor complications of the hole wound. Pelvic abscess developed postoperatively in one. The average operative time was 34 minutes, and the hospital stay was 6 8 days.[WT5”HZ] Conclusion [WT5”BZ] The microlaparoscopy is a useful technique for the diagnosis and treatment of acute abdomen with a high sensitivity of dignosis and minimal invasion.