腹腔镜在外科急腹症中的应用研究

目的探讨腹腔镜在外科急腹症中的应用价值。方法对我院2003年6月～2006年3月间应用腹腔镜诊治的80例急腹症患者的临床资料进行回顾性分析。并对施行腹腔镜手术的35例急性阑尾炎病人和以往常规开腹手术32例急性阑尾炎病人在手术时间、麻醉时间、术中出血、术后进食时间、术后止痛药用量、术后住院天数进行比较。结果本组80例急腹症中77例运用腹腔镜治疗成功（96．3％），3例中转手术（3．7％），本组无死亡病例，无手术后腹腔残余脓肿及胃肠瘘、伤口感染。腹腔镜手术的35例急性阑尾炎病人平均术中出血、术后进食时间、术后止痛药用量、术后住院天数比常规开腹手术短。结论腹腔镜在外科急腹症中的应用具有损伤少、痛苦轻、术后恢复快和安全有效、并发症少等优点，在基层医院亦可推广使用。     

单孔腹腔镜技术在急腹症诊治中的应用(附78例报告)

目的:探讨单孔腹腔镜手术在临床急腹症诊断与治疗中的应用价值。方法:回顾分析为78例急腹症患者行单孔腹腔镜手术的临床资料。其中急性胆囊炎并胆囊结石39例,急性阑尾炎18例,腹部闭合性损伤2例,空腔脏器穿孔3例,16例术前不能确定诊断。结果:78例均经单孔腹腔镜探查确诊,术前不能确诊的16例患者中,急性腹膜炎并盆腔积液3例,急性输卵管炎2例,急性肠系膜淋巴结炎2例,不全性肠梗阻5例,腹腔肿瘤4例。69例在腹腔镜下成功施行手术治疗,7例中转开腹,2例明确诊断后行非手术治疗。患者均治愈出院,无术后并发症发生。结论:单孔腹腔镜对急腹症患者具有确定诊断与治疗的作用,术中探查范围广,可降低阴性剖腹探查率,实现整体微创、精准外科的目的,值得临床推广应用。     

基层医院腹腔镜诊治外科急腹症的体会

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。     

腹腔镜治疗妇科急腹症55例临床分析

目的:评价腹腔镜对诊治妇科急腹症的临床价值。方法:应用腹腔镜对以急性腹痛为临床表现且初步排除急性盆腔炎症后的妇科急症55例进行了腹腔镜手术并进行临床分析。结果:腹腔镜在妇科急腹症中的应用范围日益扩大,绝大多数妇科急腹症可在腹腔镜下进行。结论:与传统的开腹手术相比,腹腔镜妇科急腹症手术具有切口小,出血少,患者康复快,术后不留疤痕等优点,适合在妇科急腹症中应用。     

急诊腹腔镜的临床应用体会(附122例报告)

目的:探讨腹腔镜诊治外科急腹症的价值。方法:回顾分析122例腹腔镜急腹症手术的临床资料,其中急性胆囊炎47例,急性阑尾炎69例,胃穿孔4例,宫外孕2例。结果:122例患者中,122例患者,120例在腹腔镜下完成手术,成功率达98.36%,中转开腹2例,无严重并发症发生。结论:腹腔镜技术应用于外科急腹症,既可明确诊断,又能同时进行治疗,治疗成功率高,值得临床推广应用。     

腹腔镜技术在外科急腹症诊疗中的应用

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。     

腹腔镜技术在急腹症和腹部外伤中的应用

目的:探讨腹腔镜用于普通外科急腹症和腹部外伤的价值。方法:回顾分析2005年4月至2008年8月作者用腹腔镜诊治急腹症48例患者的临床资料。结果:48例患者中,胃十二指肠溃疡穿孔13例,急性阑尾炎9例,急性胆囊炎17例,腹部闭合性损伤4例,腹部开放性损伤1例,急性盆腔炎2例,肠梗阻2例。48例患者均在腹腔镜下确诊,43例在腹腔镜下完成手术,5例中转开腹。患者均获痊愈,无术后并发症及围手术期死亡。结论:腹腔镜技术集诊断与治疗于一体,是治疗急腹症和腹部外伤的有效方法。     

腹腔镜探查术在非创伤性急腹症中的临床应用(附101例报告)

目的:探讨腹腔镜探查术在非创伤性急腹症中的临床应用价值。方法:回顾分析2011年8月至2014年7月为101例非创伤性急腹症患者行腹腔镜探查术的临床资料,其中男69例,女32例,11~78岁,平均(44.6±11.5)岁。结果:101例非创伤性急腹症患者通过腹腔镜探查术均明确诊断,其中9例中转开腹;92例患者直接在腹腔镜下完成确定性手术,术中出血量平均(28.0±7.0)ml,手术时间平均(80.0±11.3)min,平均住院(5.0±1.0)d,术后1~2 d下床活动,术后无并发症发生,患者均痊愈出院。结论:腹腔镜探查术具有诊断与治疗非创伤性急腹症的双重作用,具有微创、直观、安全、康复快等优点,在治疗急腹症方面具有显著的优越性及临床应用价值。     

腹腔镜在不明原因急腹症诊治中的应用

目的:探讨腹腔镜在诊断和治疗不明原因急腹症中的作用。方法:回顾分析1992年6月至2004年5月收治的不明原因急腹症84例的临床资料。结果:84例均在腹腔镜下明确诊断,其中68例(81％)在镜下完成手术,8例(9.5％)中转开腹,8例(9.5％)明确诊断后保守治疗。所有病例经腹腔镜探查或治疗后无并发症和死亡发生。腹腔镜术后2-7d出院。结论:腹腔镜诊断不明原因的急腹症不仅准确率高,而且大部分患者可在镜下完成手术,部分不需手术处理的患者避免了不必要的开腹探查,即使需要中转开腹,可在镜下决定开腹手术合适的切口位置及手术方式。     

腹腔镜诊治急腹症在基层医院的临床应用

目的:探讨腹腔镜手术诊治急腹症的临床应用价值。方法:回顾分析2006年1月至2013年2月116例腹腔镜急诊手术的临床资料,其中急性胆囊炎48例,急性阑尾炎32例,胃十二指肠穿孔19例,闭合性腹部损伤12例,宫外孕1例,黄体破裂1例,急性盆腔炎2例,大网膜蒂扭转坏死1例。结果:102例顺利完成腹腔镜手术,14例中转开腹;无严重并发症发生及死亡病例。结论:腹腔镜技术诊治外科急腹症,在明确诊断的同时可进行治疗,手术成功率高,使患者避免了不必要的剖腹手术,疗效好,值得进一步推广应用。     

腹腔镜技术治疗老年急腹症的临床价值

目的:探讨腹腔镜技术治疗老年急腹症患者的临床价值。方法:回顾分析2007年1月至2015年12月收治的216例老年急腹症患者的临床资料,其中115例采用腹腔镜治疗(腹腔镜组),101例行开腹探查(开腹组)。结果:腹腔镜组术中出血量、下床活动时间、肛门恢复排气时间、住院时间、并发症发生率优于开腹组,差异有统计学意义(P0.05);急性阑尾炎、上消化道穿孔、粘连性肠梗阻老年患者腹腔镜组术中出血量、下床活动时间、恢复排气时间、住院时间少于开腹组,差异有统计学意义(P0.05)。结论:腹腔镜手术治疗老年急腹症尤其急性阑尾炎、上消化道穿孔、肠梗阻患者安全、有效。     

Laparoscopy for diagnosis and treatment of acute abdominal pain

PURPOSE: To evaluate the role of laparoscopy in the diagnosis and treatment of unexplained acute abdominal pain. PATIENTS AND METHODS: Fifty-six patients with acute abdominal pain (41 women, 15 men; median age 27) who attended our hospital between July 1996 and July 1999 and in whom a definite diagnosis could not be made by conventional methods underwent diagnostic laparoscopy. RESULTS: The laparoscopic procedure was performed under general anesthesia in 43 patients and local anesthesia in 13 patients. The median duration of laparoscopy was 16 minutes. The sensitivity and specificity of diagnostic laparoscopy were found to be 98% and 96%, respectively. The most frequent diagnosis was acute appendicitis (38%). Laparoscopic treatment of the surgical pathology was possible in 36 patients; in seven patients, conversion to laparotomy was necessary. The median postoperative hospital stay was 1 day in the diagnostic laparoscopy group. The median treatment cost was lower in the diagnostic laparoscopy group than in the therapeutic laparoscopy or laparotomy groups. There was no mortality or morbidity in the laparoscopy groups. CONCLUSIONS: Laparoscopy is an effective method for the diagnosis and treatment of surgical pathologies in patients in whom the diagnosis cannot be made with physical examination and noninvasive methods.     

Laparoscopic diagnosis and treatment of primary torsion of the greater omentum

Clinical presentation of primary torsion of the greater omentum is nonspecific, thus rarely allowing for a preoperative diagnosis. Three patients presented with acute but nonspecific abdominal symptoms. Because ultrasonographic and radiologic findings were unclear, all patients underwent diagnostic laparoscopy. In all cases, laparoscopy enabled us to achieve the diagnosis and to perform a resection of necrotic omentum. The mean duration of the procedure was 56 minutes (range: 42 to 76). The postoperative course was uneventful and the patients were discharged on postoperative day 1 (2) and 3. The value of diagnostic laparoscopy increases when the disease can be treated laparoscopically. The laparoscopic vision allowed us to explore the whole peritoneal cavity, so achieving the diagnosis, and to place the operative trocars at the most convenient sites. The laparoscopic resection of the greater omentum is an easy task even for inexperienced laparoscopic surgeons, allowing patients to benefit from the advantages of a mini-invasive approach.     

LAPAROSCOPIC APPENDICECTOMY A PROSPECTIVE ANALYSIS

The potential advantages of laparoscopic surgery for a number of abdominal operations including appendicectomy have been heralded. In this study the aims were to assess prospectively the role of routine diagnostic laparoscopy in the diagnosis of acute appendicitis and determine the efficacy of laparoscopic appendicectomy. Patients with suspected acute appendicitis had diagnostic laparoscopy. When the diagnosis was confirmed laparoscopic appendicectomy was performed. Where an alternative diagnosis was made the appropriate treatment was instituted. If no diagnosis could be made the macroscopically normal appendix was removed by laparoscopic appendicectomy. Eighty-one patients (50 female, 31 male) had an initial diagnostic laparoscopy; 53 had appendicitis and proceeded to laparoscopic appendicectomy. A diagnosis could not be established at diagnostic laparoscopy in six patients and they also proceeded to laparoscopic appendicectomy. An alternative diagnosis was made in the remaining 22 patients (19 female and 3 male), with five proceeding to laparotomy and one patient with mesenteric adenitis having laparoscopic appendicectomy. Seven patients having laparoscopic appendicectomy required conversion to an open operation due to a retrocaecal³ or perforated⁴ appendix. The median operating time for successful laparoscopic appendicectomy was 55 min (range 30–95). Morbidity occurred in five of 53 patients having a successful laparoscopic appendicectomy. The median postoperative hospital stay was 2 days. The median time before return to normal activities was 8 days. Diagnostic laparoscopy is a useful diagnostic technique in women with suspected acute appendicitis, as it improves diagnostic accuracy, reduces the negative appendicectomy rate and avoids unnecessary laparotomy. Laparoscopic appendicectomy is a significant technical advance in the management of acute appendicitis. Preliminary results reveal similar morbidity to open appendicectomy with the potential advantages of a reduced postoperative hospital stay and a more rapid return to normal activities. Randomized trials are required to confirm this.     

Operative laparoscopy in pregnancy.

OBJECTIVE: We compared the surgical outcomes of pregnant women undergoing laparotomy in the first 2 trimesters of pregnancy with those undergoing laparoscopy for the management of acute pelvic pain. METHODS: We performed a systematic retrospective chart review of patients whose discharge diagnosis included intrauterine pregnancy with exploratory laparotomy or laparoscopy from August 1, 1993 to October 31, 1999. The following factors were assessed: preoperative diagnosis, postoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complications, and outcome of the pregnancy in both groups. RESULTS: Sixteen pregnant patients underwent surgery during the study period. All but one had abdominopelvic pain, and all patients had an associated adnexal mass. The mean gestation age at the time of surgery was 15+/-6 weeks versus 13+/-4 weeks in the laparoscopic and laparotomy groups, respectively (P=NS). All patients undergoing laparoscopy remained in the hospital for one day compared with a mean of 4.4+/-1.1 days in the laparotomy group (P<0.0001). Pregnancy outcomes were similar and uniformly good. CONCLUSION: Laparotomy can be avoided and pregnant patients managed safely by operative laparoscopy, with shorter hospital stays.     

Laparoscopy-assisted resection of complicated Meckel's diverticulum in adults

The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckel's diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckel's diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckel's diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckel's diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckel's diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.     

微创技术在急腹症中的应用研究

目的：探讨腹腔镜技术在外科急腹症中的诊断与治疗价值。方法：回顾性分析64例腹腔镜外科急腹症探查及治疗效果。结果：所有病例经腹腔镜探查全部明确诊断,临床治疗效果满意,无术后并发症及死亡。结论：急诊腹腔镜探查及手术,可以提高急腹症的确诊率,降低剖腹探查阴性率。     

腹腔镜诊治急腹症在基层医院中的应用体会

目的:探讨基层医院利用腹腔镜技术诊治急腹症的临床应用价值。方法:回顾分析2010年1月至2012年12月为204例急腹症患者行腹腔镜探查及治疗的临床资料。结果:患者均经腹腔镜探查获得确诊,其中急性阑尾炎86例,急性胆囊炎46例,急性上消化道穿孔30例,肠梗阻26例,卵巢黄体破裂6例,急性盆腔炎10例。186例于镜下完成治疗,18例中转开腹。其中83例行阑尾切除术,39例行胆囊切除术,30例行胃十二指肠溃疡穿孔修补术,11例行肠粘连松解术,7例行小肠部分切除术,6例行卵巢病灶切除术,10例盆腔炎行盆腔冲洗术。纠正术前诊断16例,14例发生手术并发症。平均住院(5.2±0.8)d。结论:腹腔镜技术可提高急腹症的确诊率,指导治疗,避免阴性探查,具有疗效确切、手术并发症少、术后康复快等优点,在基层医院中应用前景广阔。     

Routine use of laparoscopy in patients with clinically doubtful diagnosis of appendicitis

BACKGROUND: Therapeutic and diagnostic laparoscopy, a minimal invasive technique, has been used effectively and frequently for appendicitis by surgeons. There is still controversy about whether this technique should be applied to all patients or in the setting of a doubt of the diagnosis of appendicitis, especially for women. Based on these controversies, the aim of this study was to assess the safety and efficacy of diagnostic and therapeutic laparoscopy for patients with suspected peritonitis imitating acute appendicitis. PATIENTS AND METHODS: Between May 2002 and September 2006, a consecutive series of 74 patients operated on for suspected acute lower quadrant peritonitis were studied retrospectively. Despite being unclear, the preoperative diagnoses were thought to be suspected peritonitis imitating acute appendicitis. Therefore, patients all had diagnostic and therapeutic laparoscopy. RESULTS: Seventy-four patients included in this study were successfully operated on by laparoscopy. Thirty-five of these patients were diagnosed with appendicitis and had an appendectomy by laparoscopy. Six of the 35 patients were converted to a conventional open appendectomy because of retrocecal localization and perforated appendicitis. In the 29 of the remaining 39 patients, pelvic inflammatory disease, mesenteric lenfadenopathy, torsed omentum and ruptured hemorrhagic, and endometrial or simple ovarian cysts were revealed. So, these 29 patients' (39.1%) appendices were left in place, and an unnecessary appendectomy was avoided, thereby reducing the negative appendectomy rate. In the remaining 10 patients, nothing was found to explain the clinical signs. After a mean follow-up period of 16 months, postoperative evaluations of the patients were satisfactory. CONCLUSION: Laparoscopy, a single procedure and an accurate modality for the diagnosis and treatment of patients with acute abdominal conditions, can be recommended in patients, especially fertile women, with suspected peritonitis imitating acute appendicitis when the diagnosis cannot be made by physical examination and noninvasive methods.     

腹腔镜诊治女性急性右下腹痛

目的 :探讨腹腔镜诊断和治疗不明原因女性急性右下腹痛的作用。方法 :回顾分析不明原因女性急性右下腹痛 1 1 5例的临床资料。结果 :1 1 5例不明原因女性急性右下腹痛均在腹腔镜下明确诊断 ,除 5例中转开腹外 ,其余病例均在腹腔镜下完成手术。所有病例经腹腔镜探查或治疗后均无严重并发症 ,术后 2～ 6d出院。结论 :腹腔镜诊断不明原因的女性急性右下腹痛准确率高 ,减少了患者的痛苦 ,缩短了住院时间。腹腔镜手术可作为诊治女性不明原因右下腹痛的首选方法。