基层医院腹腔镜技术在急腹症中的应用

2002年1月～2011年3月我科应用腹腔镜对232例急腹症进行探查、手术,227例完成腹腔镜诊断和治疗,2例因胆囊三角冰冻样改变、3例因阑尾周围脓肿中转开腹手术。232例随访3～12个月,平均3.5月,其中随访>6个月89例:1例阑尾切除术后6个月左侧戳孔发生网膜内疝再次手术11 d后痊愈;1例阑尾切除术后12个月右下腹再发疼痛2次,考虑网膜粘连,给予消炎治疗后未再发;6例十二指肠球部穿孔有轻度嗳气、返酸等消化道症状;其余病人均无并发症发生。我们认为腹腔镜诊断和治疗急腹症安全、有效,其微创优势得到充分发挥,也适于女性右下腹急症明确诊断,尤其适合外伤性和病理性急腹症的早诊断、早治疗。严格选择适应证、合理中转手术是急腹症腹腔镜一体化诊疗能否顺利完成的关键。

Laparoscopy for Acute Abdominal Diseases in Basic Level Hospitals

From January 2002 to March 2011,we carried out laparoscopic abdominal exploration on 232 patients with acute abdominal diseases,227 of the patients received laparoscopic diagnosis and treatment,and the other 5 patients were converted to open surgery because of frozen gallbladder triangle(2 cases) or abscess of the appendix(3 cases).The patients were followed up for 3 to 12 months with a mean of 5 months(>6 months in 89 cases),during which 1 patient developed left hole retina hernia 6 months after appendectomy,and then recovered in 11 days after a second surgery;1 patients complained of recurrent pain at the right lower abdomen for twice in 12 months after appendectomy,and retinal adhesion was therefore considered,thus anti-inflammation was carried out;6 patients,who had duodenum perforation,showed mild belching and acid regurgitation;no other complications were reported.We believe that laparoscopy is safe and effective for the diagnosis and treatment of acute abdominal diseases,especially for traumatic and pathological acute abdominal diseases.Strict indications and right timing for conversion to open surgery are the keys to the success of the procedure.