腹腔镜在妇科急症中的应用

目的:探讨腹腔镜在妇科急症中的应用价值。方法:2002年以来,应用腹腔镜行妇科急症手术85例,其中异位妊娠62例中行患侧输卵管切除术36例,输卵管切开取胚术及病灶清除术23例,1例卵巢妊娠行卵巢部分切除术,输卵管病灶注药术2例;卵巢破裂10例,9例行电凝止血术,1例行患侧附件切除术;卵巢肿瘤蒂扭转6例,2例不全扭转行囊肿剥除术,4例完全扭转附件坏死行一侧附件切除术;急性盆腔炎7例,行脓肿清除、输卵管切除及盆腔粘连松解术。结果:85例急诊腹腔镜手术全部顺利完成,无一例并发症。结论:腹腔镜治疗妇科急症安全有效,较开腹手术有很多优越性。     

单孔免气腹腹腔镜妇科手术71例报告

目的:探讨单孔免气腹腹腔镜妇科手术的可行性、安全性及临床效果。方法:全麻下采用单孔法置入腹腔镜器械,根据不同疾病采取相应的手术方法,异位妊娠术式为输卵管切除术,输卵管开窗术或输卵管切开取胚术;卵巢囊肿手术采用囊肿剥除术及卵巢成形术、卵巢部分切除术。结果:71例手术均顺利完成,无脏器损伤、皮下出血及其他并发症发生,手术时间平均(62.46±20.04)min,术中失血量平均(18.71±14.94)ml,术后平均住院(4.83±1.28)d。结论:单孔免气腹腹腔镜手术治疗异位妊娠、卵巢囊肿等妇科疾病快速、安全、有效,具有出血少、康复快、并发症少等优点,可作为常规手术加以推广应用。     

腹腔镜诊治妇科急腹症的临床应用

目的:探讨腹腔镜诊断和治疗妇科急腹症的价值。方法:回顾分析应用腹腔镜诊断和治疗妇科急腹症41例的临床资料。结果:腹腔镜诊断并对36例异位妊娠、3例黄体破裂、2例卵巢肿瘤扭转成功进行手术治疗,其中输卵管切除术34例,附件切除术2例,保守性手术如输卵管开窗清除胚胎病灶和卵巢电凝止血术5例。术后3～5d痊愈出院。结论:应用腹腔镜诊断和治疗妇科急腹症有效、实用、微创。     

腹腔镜诊治妇科急腹症的临床应用

目的 :探讨腹腔镜诊断和治疗妇科急腹症的价值。方法 :回顾分析应用腹腔镜诊断和治疗妇科急腹症 5 2例的临床资料。结果 :腹腔镜诊断并对 36例异位任娠、8例黄体破裂、8例卵巢肿瘤蒂扭转成功进行手术治疗 ,其中输卵管切除术 2 6例、附件切除术 5例、卵巢囊肿剥除术 3例 ,保守性手术如输卵管开窗清除胚胎和卵巢电凝止血术 1 8例。术后 3～ 5d均痊愈出院。结论 :运用腹腔镜诊断和治疗妇科急腹症有效、实用。     

妇科腹腔镜手术271例临床分析

目的:探讨腹腔镜手术用于治疗妇科疾病的临床价值。方法:回顾分析为271例患者行腹腔镜妇科手术的临床资料,评价平均手术时间、术中出血量等指标。结果:271例均在腹腔镜下完成手术,包括腹腔镜全子宫切除术83例,次全切除术80例,子宫肌瘤切除术42例,附件切除术33例,附件囊肿剥除术28例,输卵管妊娠取胚术5例。2例(0.74%)发生并发症。结论:腹腔镜妇科手术患者创伤小,康复快,只要严格掌握手术适应证,大部分妇科良性疾病可用腹腔镜手术治疗。     

初期开展腹腔镜技术诊治妇科疾病142例临床分析

目的:探讨腹腔镜手术用于诊治妇科疾病的价值,总结初期开展妇科腹腔镜手术的体会。方法:回顾分析初期开展142例妇科腹腔镜手术的临床资料,主要包括输卵管切开取胚术、输卵管切除术、卵巢囊肿剥除术、附件切除术、输卵管结扎术、子宫肌瘤切除术、盆腔粘连松解术、输卵管造口术、腹腔镜辅助阴式子宫切除术等13种手术。结果:142例中136例(95.8%)成功完成腹腔镜手术,6例中转开腹(4.2%),6例(4.2%)发生并发症,平均手术时间(102.43±42.85)min,平均术中出血20ml。结论:腹腔镜手术具有患者创伤小、术中出血少、术后康复快、住院时间短、腹壁切口美观且诊断和治疗同步完成等优点,但初期开展此手术须严格掌握适应证并熟悉各种并发症的防治,从而使腹腔镜技术诊治妇科疾病有更广阔的应用前景。     

腹腔镜妇科手术60例临床分析

目的 :探讨腹腔镜手术在诊治妇科疾病的临床价值。方法 :回顾分析腹腔镜妇科手术 6 0例的临床资料。结果 :卵巢囊肿切除术 4 1例 ,子宫肌瘤切除术 7例 ,输卵管妊娠手术 5例 ,子宫切除术 3例 ,子宫附件切除术 3例 ,腹腔镜探查术 1例。术后皮下瘀血 2例 ,皮下气肿 1例 ,总并发症率为 5 %。结论 :腹腔镜手术治疗妇科良性疾病具有创伤小、疼痛轻、恢复快等优点 ,但需降低手术并发症率。     

电视腹腔镜手术在妇科的应用（附64例报告）

应用电视腹腔镜施行妇科手术64例,包括输卵管切除术、输卵管造口术、输卵管伞端扩张术、输卵管扎管术、卵巢或附件切除术、卵巢囊肿剥出成形术、卵巢穿刺术、卵巢冠囊肿切除术、子宫肌瘤挖除术及盆腔粘连分解术等。结果表明:利用电视腹腔镜施行妇科手术,具有手术时间短、损伤小、采后恢复快、并发症少等优点,值得推广应用。     

腹腔镜输卵管开窗取胚术治疗输卵管妊娠临床价值研究

目的 探讨腹腔镜输卵管开窗取胚术对输卵管妊娠患者的临床应用价值.方法 回顾性分析2017-09—2019-08濮阳市妇幼保健院妇科行腹腔镜手术治疗的80例输卵管妊娠患者的临床资料.按手术方法分为输卵管开窗取胚术组(开窗取胚组)和输卵管切除术组(切除术组),每组40例.比较2组患者的基线资料.记录手术时间、术中出血量,以...     

腹腔镜治疗输卵管妊娠120例临床分析

目的总结腹腔镜手术治疗输卵管妊娠的经验。方法回顾性分析我院2012年1月～2013年6月120例输卵管妊娠患者应用腹腔镜治疗的临床效果,其中32例行切开取胚术,88例行输卵管切除术。结果手术均获成功,手术时间（32±12）min,其中10例腹腔内出血〉800ml。无并发症发生。4例保留输卵管者术后补充甲氨蝶呤50mg／m2肌内注射1次,无持续性输卵管妊娠。输卵管妊娠腹腔镜下手术与传统开腹手术相比具有手术时间短、术中出血量少,平均住院时间少、术后恢复快等优点;而腹腔镜下输卵管切除术较切开取胚术具有手术时间短、术中出血少、治愈率高等优点。结论腹腔镜下手术治疗输卵管妊娠是一种简便有效、安全可靠、术后恢复快的微创治疗方法,是目前治疗输卵管妊娠的主要方法。     

基层医院急诊腹腔镜在腹部外伤中的应用体会

目的:探讨急诊腹腔镜手术诊治腹部外伤的有效性。方法:2011年1月至2016年8月应用急诊腹腔镜诊治腹部创伤患者187例,并与同期186例传统剖腹探查病例进行对比,分析急诊腹腔镜在腹部创伤诊治中的及时性、诊断率、治疗率、非治疗性手术率等。结果:腔镜组187例均在腹腔镜下明确诊断或治疗,诊断率100%,139例(74.3%)在腹腔镜下完成治疗,16例(8.6%)未发现明显病灶无需处理,32例(17.1%)中转开腹。术后肠鸣音恢复时间平均(2.5±0.9)d,较剖腹组[(3.5±1.4)d]短(P0.05)。未发生腹腔镜相关并发症。结论:急诊腹腔镜诊治腹部损伤安全、可行,可及时做出正确诊断并予以治疗,提高抢救时效,加快康复。     

腹腔镜在不明原因急腹症中的应用

目的:探讨腹腔镜在不明原因急腹症中的临床应用价值。方法:对16例不明原因急腹症患者采用腹腔镜探查并进行诊治,回顾分析其临床资料。结果:所有病例全部确诊病因,15例在腹腔镜下完成手术,1例中转开腹,无手术死亡。术后无伤口感染及其他并发症发生。结论:腹腔镜技术在急腹症诊断及治疗中具有安全、可靠、微创的特点,尤其在鉴别诊断中具有很高的价值。     

Emergency laparoscopy for acute abdominal conditions: a prospective study

BACKGROUND: Currently, emergency laparoscopic surgery for acute abdominal conditions has become the favored surgical approach; therefore, we investigated the diagnostic accuracy and therapeutic efficacy of laparoscopy in acute abdominal pain in Saudi Arabian patients. PATIENTS AND METHODS: In this prospective study, 176 patients with acute abdominal pain (113 patients with pain localized to the right iliac region [group A] and 63 patients with generalized abdominal pain [group B] underwent emergency laparoscopy between January 2002 and December 2006. We evaluated the initial clinical diagnosis, the laparoscopic diagnosis, and the outcome in these two groups of patients. RESULTS: In group A, a definitive diagnosis was established at laparoscopy in 89% of patients, and it was therapeutic in 81.4% of the patients, and in 9 patients (8%) a conversion to laparotomy was necessary a to manage their condition. In group B, the diagnosis was accurate in 87% of patients, and it was therapeutic in 79.4% of the patients, and in 5 patients (8%) a conversion to laparotomy was necessary. There was no mortality. CONCLUSIONS: The emergency laparoscopy is a diagnostic and therapeutic option in the majority of acute abdominal pain conditions.     

Role of laparoscopy in blunt perforations of the small bowel

Background: The purpose of this study was to determine whether laparoscopy could improve our ability to diagnose and treat perforations of the small bowel. Methods: From 1985 to 2001, among 250 patients admitted for a blunt abdominal trauma, 195 surgical explorations were performed, comprising 42 laparoscopies. On admission, 108 patients underwent an abdominal ultrasonography (US) and 104 a computed tomography (CT). Thirty-nine patients had a blunt small bowel trauma (BSBT) that was explored and/or treated by laparoscopy (n = 15) or celiotomy (n = 24). We compared the patients who underwent emergency surgery (23) and those who were operated on after a mean delay of 51 h. Results: On admission, for detecting free intraperitoneal fluid with a BSBT, the sensitivity of CT was 93.3% and specificity was 13.6%. Regarding the 23 patients who underwent emergency surgery, 8/20 had positive US and 10/15 had positive CT, whereas the 15 celiotomies and 8 laparoscopies indicated BSBT. Regarding the 16 patients who underwent delayed surgery, 9 patients underwent a celiotomy and 7 a laparoscopy; all BSBTs were diagnosed. In searching for BSBT, the sensitivity and specificity of laparoscopy were both 100%, whereas the sensitivity of CT was 83.3% and specificity was 22.2%. Twenty of 23 patients undergoing emergency surgery had bowel suture repair compared to 3/16 after delayed surgery. In contrast, a resection was necessary in 10/12 patients treated after a delay compared to 2/17 operated in emergency. Five BSBTs were sutured by laparoscopy, whereas 10 required conversion. Laparoscopy avoided celiotomy in 15 cases. There were no deaths and no enterostomy. Conclusion: In hemodynamically stable patients with blunt abdominal trauma, laparoscopy safely and effectively identifies small bowel injuries. Early recognition of these injuries and timely surgical treatment offer the best prognosis.     

Emergency laparoscopyrid=""

BACKGROUND: By now, laparoscopic surgery has achieved widespread acceptance among surgeons and, generally speaking, by the public. Therefore, we set out to evaluate whether this technique is a feasible method of treating patients with abdominal emergencies, traumatic or not. To assess the routine use of emergency laparoscopy in a community hospital setting, we undertook a retrospective analysis of an unrandomized experience (presence or absence of a surgeon with laparoscopic experience). METHODS: Between January 1993 and October 1998, 575 emergency abdominal surgical procedures were done in our department. In all, 365 (63.4%) were diagnostic and operative laparoscopy procedures (acute small bowel obstruction: 23 cases; hernia disease: one case; gastroduodenal ulcer disease: 15 cases; biliary system disease: 89 cases; pelvic disease: 237 cases). These cases represent almost 56% of all laparoscopic procedures done during the same period at our institution. Laparoscopy was not performed in patients with a history of a previous abdominal approach to malignant disease, a history of more than two major abdominal surgeries, or massive bowel distension; nor was it used in patients whose general conditions contraindicate this approach. RESULTS: The conversion rate was 6.8%. The morbidity and mortality rates were, respectively, 4.1% and 0.8%. A definitive diagnosis was provided in 95.3% of cases, with the possibility to treat 88.2% of them by laparoscopy. CONCLUSIONS: We consider the laparoscopic approach in patients with abdominal emergencies to be feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities. Sparing patients laparotomy reduces postoperative pain, improves recovery of GI function, reduces hospitalization, cuts health care costs, and improves cosmetic results. This approach promises to play a significant role in emergency abdominal situations and will certainly become increasingly important in today's health care environment.     

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。     

Laparoscopy in gastrointestinal emergency

Summary BACKGROUND: Laparoscopy is an established component of modern visceral surgery. To one extent or another, it is used for operations on virtually all abdominal organs, depending on the specialization and expertise of the respective department. In spite of its extensive use, there are no clear guidelines for the application of laparoscopy in acute situations. The reports in the literature do not at present suffice for the formulation of such guidelines. METHODS: This survey covers the role of laparoscopy in seven different types of emergency abdominal surgery. We carefully evaluated the relevant literature on the use of laparoscopy in emergency abdominal surgery. RESULTS: Many relevant works are case reports or uncontrolled series that are only concerned with feasibility. Further, comparative studies often have poor selection criteria and so cannot provide a reliable answer to the question as to whether laparoscopic technique should be used in gastrointestinal emergencies. Our experience shows that laparoscopy is also suitable for acute abdominal situations. CONCLUSIONS: Laparoscopy can be successfully applied for all seven indications considered here. Patient safety and efficacy depend on the experience and manual dexterity of the laparoscopic surgeon. It should be borne in mind that in emergency settings, it is important to recognize in time the need to convert to open surgery     

Systemic stress response during operations for acute abdominal pain performed via laparoscopy or laparotomy in children

We compared the endocrine and metabolic changes during acute emergency abdominal surgery performed using either laparoscopy or laparotomy in children. Twenty-nine children aged 1.5-14 years were assigned to undergo laparoscopy (n = 15) or laparotomy (n = 14) with a standard anaesthesia technique. Arterial blood gases and blood prolactin, cortisol, interleukin-6, glucose, insulin, lactic acid and epinephrine levels were determined 5 min after the induction of anaesthesia, 30 min into surgery and at the end of surgery. Intra-operative heart rate and mean arterial pressure were stable in both groups. In the laparoscopy group, slight respiratory acidosis occurred during surgery (p < 0.01) but there were no changes in the laparotomy group. Insulin, cortisol, prolactin, epinephrine, lactate and blood glucose levels increased in both groups (p < 0.05) although there was no difference between the groups. The surgical stress and trauma imposed by laparoscopy seems similar to that caused by laparotomy in children undergoing emergency abdominal surgery.     

Laparoscopy in Non-Trauma Abdominal Emergencies

The role for laparoscopy has evolved throughout the years and more evidence has become available to support its use in abdominal emergencies. Although the literature has expanded and more randomized controlled trials are available, skepticism persists concerning the use of laparoscopy in emergency situations. We attempt to provide the readers with a concise review and highlight the most relevant issues and available evidence in seven different non-trauma abdominal emergencies.     

Laparoscopy in the management of children with chronic recurrent abdominal pain.

BACKGROUND AND OBJECTIVES: The purpose of the present study was to evaluate the results of diagnostic laparoscopy in children with chronic recurrent abdominal pain. PATIENTS AND METHODS: Thirteen children with chronic recurrent abdominal pain were subjected to diagnostic laparoscopy. Ages varied from 10 to 17 years. There were six males and seven females. Abdominal pain was present from 3 weeks to 12 months (mean, 2 months). Extensive laboratory and imaging studies did not contribute to the diagnosis. In all patients, the pain was disabling and severe enough to warrant repeated visits to the pediatrician, emergency room visits, or hospital admissions, as well as absence from school. RESULTS: All children recovered uneventfully. Laparoscopic findings that identified the cause of abdominal pain were obtained in 12 of 13 patients. Laparoscopic appendectomy was done in all patients. There were no operative complications. One child presented three months later with incomplete small bowel obstruction, which resolved with conservative management. There were no other postoperative complications. Follow-up varied from six months to three years. Abdominal pain resolved in ten patients. One patient presented eight months later with biliary dyskinesia. She improved following laparoscopic cholecystectomy and later on sphincterotomy, but her pain has not yet completely resolved. One patient presented six months later with abdominal pain secondary to intestinal adhesions. Her pain completely resolved after laparoscopic lysis of adhesions. A third patient who developed lower abdominal pain six months after laparoscopy improved with conservative management and antibiotics for pelvic inflammatory disease. CONCLUSIONS: Diagnostic laparoscopy is a valuable procedure in the management of children with chronic recurrent abdominal pain. In the present study, laparoscopic examination revealed the cause of abdominal pain in most patients, and this pain resolved in most cases. Based on our experience, we recommend diagnostic laparoscopy early in the course of debilitating chronic recurrent abdominal pain in children. Appendectomy should be done when no other significant cause of abdominal pain has been identified, even if the appendix looks normal.