腹腔镜技术在外科急腹症诊疗中的应用

Application of Laparoscopy in The Diagnosis and Treatment of Acute Abdomen

目的探讨在外科急腹症诊疗过程中应用腹腔镜技术的可行性。方法回顾性分析2012年1月至2013年12月期间于笔者所在医院行腹腔镜探查及治疗的81例外科急腹症患者的临床资料。结果 81例急腹症患者包括急性阑尾炎38例,胃穿孔15例,十二指肠溃疡穿孔10例,急性胆囊炎10例,肠系膜动脉栓塞1例,腹内疝2例,回盲部肿瘤2例,乙状结肠自发性破裂2例,肠粘连1例。81例患者均行腹腔镜探查,其中79例于术中明确诊断,明确诊断率达97.5%;成功行一期腹腔镜手术73例,成功率为90.1%,余8例中转开腹;手术时间35~191 min,平均76 min;术中出血20~130 m L,平均43 m L;术后住院时间3~13 d,平均5.6 d。术后76例患者获访,随访时间为2~24个月,中位数为14个月,随访期间均无远期并发症发生,1例回盲部恶性肿瘤患者发生肺转移。结论腹腔镜技术具有创伤小的优点,可作为急腹症首选的诊断和治疗方式。

Objective To investigate the feasibility of laparoscopy in the diagnosis and treatment of acute abdomen. Methods The clinical data of 81 patients with acute abdomen treated in our hospital from January 2012 to December 2013 were retrospectively analyzed. Results Of the 81 patients with acute abdomen, there were 38 cases of acute appendicitis, 15 cases of gastric perforation, 10 cases of duodenal ulcer perforation, 10 cases of acute cholecystitis, 1 case of mesenteric artery embolism, 2 cases of internal hernias, 2 cases of ileocecal tumor, 2 cases of sigmoid colon rupture, 1 case of intestinal adhesion. The 81 cases were treated by laparoscopy, including 79 cases（97.5%） were clearly diagnosed; 73 cases were succeeded by laparoscopy, and 8 cases converted to laparotomy. The operation time were 35-191 minutes, with an average of 76 minutes; the intraoperative blood loss were 20-130 m L, with an average of 43 m L; the postoperative hospital stay were 3-13 days, with an average of 5.6 days. Seventy-six patients received followed-up for 2-24 months, and the median time were 14 months, no special complications occurred during follow-up period, but 1 case of ileocecal tumor suffered from lung metastases in 12 months after operation. Conclusions Laparoscopy can be used in the preferred way of diagnosis and treatment of acute abdomen.