基层医院腹腔镜诊治外科急腹症的体会

Application of laparoscopy in the diagnosis and treatment of acute abdomen in primary hospitals

目的：探讨基层医院应用腹腔镜技术诊治急腹症的临床体会。方法：回顾分析2011年2月至2015年6月为815例急腹症患者行腹腔镜探查及治疗的临床资料,患者10-85岁,男506例,女309例。术前诊断：急性阑尾炎654例,上消化道穿孔58例,急性胆囊炎、胆囊结石48例,胆源性胰腺炎、胆总管结石13例,腹痛待查10例,肠梗阻13例,腹部外伤18例,急性胰腺炎1例。160例（19.6%）有合并症。结果：813例（99.8%）获得确诊,785例（96.3%）于镜下完成治疗,30例（3.7%）中转开腹。术后发生并发症24例（2.9%）,包括胆漏3例,肠梗阻7例,腹腔脓肿7例,结石残留1例,切口感染、脂肪液化5例,戳孔出血1例。无手术死亡病例。结论：腹腔镜手术用于急腹症诊断率高,创伤小,并发症少,术后康复快,通过积极围手术期处理,可在基层医院提供安全、有效、微创的诊治。

Objective： To evaluate the experience of laparoscopy in the diagnosis and treatment of acute abdomen in primary hospitals. Methods： The clinical data of 815 patients with acute abdomen who were diagnosed and treated by laparoscopy from Feb.2011 to Jun. 2015 were retrospectively analyzed. There were 506 males and 309 females,aging from 10 to 85 years with a mean age of（ 42. 2 ± 16. 0） years. These patients were diagnosed with acute appendicitis in 654 cases,upper gastrointestinal tract perforation in 58,acute calculous cholecystitis in 48,acute biliary pancreatitis with choledocholith in 13,unidentified abdominal pain in 10,intestinal obstruction in 13,18 cases were confirmed as having abdominal trauma,acute pancreatitis in 1 case. 160 patients（ 19. 6%） suffered from complications. Results： Eight hundred and thirteen cases（ 99. 8%） had definite diagnoses. 785 cases（ 96. 3%） were treated successfully with laparoscopy. Conversion to open surgery occurred in 30 cases（ 3. 7%）. Postoperative complications were observed in 24 cases（ 2. 9%）,including bile leakage in 3,intestinal obstruction in 7,peritoneal abscess in 7,residual stones in 1,wound infection and fat liquefaction in 5,port-site bleeding in 1. There was no death. Conclusions： Laparoscopic exploration has the advantages of high diagnostic accuracy,minimal invasion,few complications,fast recovery in the treatment of acute abdomen. It provides a safe,effective and minimally invasive measure in primary hospitals,if positive perioperative management is guaranteed.