腹腔镜在腹部外伤中的应用

目的:探讨腹腔镜诊断与治疗腹部外伤的临床价值。方法:回顾分析1996年8月至2004年8月85例腹腔镜诊治腹部外伤的临床资料。结果:85例均在腹腔镜下明确诊断,其中45例(52.9%)于镜下作治疗性手术,18例(21.2%)免作治疗性处理,22例(25.9%)中转开腹。术后并发症4例(4.7%)。全组均痊愈出院。结论:腹腔镜诊治腹部外伤具有创伤小、安全可靠、诊断率高并有效降低阴性剖腹探查率等优点。     

腹腔镜在腹部外伤中的应用体会

目的:分析腹腔镜诊断与治疗腹部外伤的临床价值。方法:2002年7月~2006年7月,我院对具有剖腹探查指征的68例腹部外伤患者使用腹腔镜诊断,并根据镜检结果决定镜下治疗或中转开腹手术。结果:51例腹部外伤于镜下作出正确诊断,19例于镜下手术,18例可免治疗性处理;31例中转开腹手术,其中9例为腹腔镜辅助开腹或手助腹腔镜手术,术后并发症5例,全组均治愈出院。结论:腹腔镜诊治腹部外伤具有创伤小、安全可靠、诊断率高,并有效降低阴性剖腹探查率等优点,适用于大部分腹部外伤的病例。     

腹腔镜在腹部外伤中的应用58例体会

目的探讨腹腔镜手术在腹部外伤中的诊断及治疗价值。方法回顾性分析2002年1月至2008年10月我院收治的58例血流动力学稳定的腹部外伤病人的临床资料。腹部外伤后使用腹腔镜探查、诊断,并根据病变情况做相应治疗处理。结果腹腔镜手术明确诊断58例,完全腹腔镜手术45例（其中探查阴性3例）,手辅助腹腔镜手术3例,中转开腹手术10例。术后伤口感染1例,膈下脓肿1例,无损伤、漏诊,无手术死亡。结论腹腔镜手术在诊治血流动力学稳定的腹部外伤时是一种安全、可行、有效的方法,并且可以减轻腹部闭合性损伤行剖腹探查阴性病人的创伤。但也存在一定的局限性,必要时配合手辅助腹腔镜或及时中转开腹手术能取得更好的治疗效果。     

腹腔镜在腹部外伤治疗中的应用

目的:分析应用腹腔镜经原创口诊断与治疗腹部外伤的临床价值。方法:2003年7月至2006年12月,对具有剖腹探查指征的14例腹部外伤患者使用腹腔镜经原创口诊断,并根据镜检结果决定镜下治疗或中转开腹手术。结果:14例腹部外伤患者均于镜下作出正确诊断,5例镜下手术,2例可免治疗性处理;7例中转开腹手术,其中5例于腹腔镜辅助下手术,全组均治愈出院。结论:腹腔镜诊治腹部外伤具有创伤小、安全可靠、诊断率高,并有效降低阴性剖腹探查率等优点,适用于大部分腹部外伤的病例。     

The role of laparoscopy in abdominal trauma.

Thirty-nine hemodynamically stable trauma patients were evaluated prospectively by laparoscopy before planned celiotomy. Laparoscopy was performed using a forward-viewing laparoscope connected to two high-resolution video monitors. The mechanism of injury was blunt trauma in eight, stab wounds (SWs) in 16, and gunshot wounds (GSWs) in 15. Laparoscopy correctly identified the presence of an intraperitoneal injury in 26 patients. Six other patients had retroperitoneal injuries, five of which were seen on laparoscopy. The remaining seven patients had no demonstrable intraperitoneal or retroperitoneal injuries, did not undergo celiotomy, and were observed without morbidity. In comparison with findings at surgery, laparoscopy identified injuries to the liver in eight of ten, to the diaphragm in three of three, to the colon in two of three, to the stomach in three of three, to the kidney in one of one, to the spleen in none of three, and to the small bowel in none of four patients. Visualization of the spleen was achieved in only one patient. The extent of the hemoperitoneum was underestimated from the laparoscopic examination in all nine patients with greater than 750 mL of peritoneal blood, four of whom had undetected active bleeding. Laparoscopy was performed easily in all patients and there were no complications associated with its use. In conclusion, the absence of an intra-abdominal injury was correctly identified with laparoscopy in 11 patients and laparoscopy may decrease the need for celiotomy in selected patients. However, the inability to "run the small bowel," visualize the spleen, and evaluate hemorrhage limits the utility of laparoscopy in determining which patients with laparoscopically visualized injuries will require celiotomy.     

The importance of laparoscopy in blunt abdominal trauma

The importance of laparoscopy in the management of blunt abdominal trauma should be evaluated. Therefore we retrospectively analysed all patients with blunt abdominal trauma treated in the Department of Surgery at the Carl-Thiem-Hospital Cottbus between 1998 and 2000. Within this period a total number of 53 patients with blunt abdominal trauma underwent operative treatment, 20 (37.7 %) of them had primary laparoscopy. Of the 11 cases where laparoscopic operation could be completed without conversion to exploratory laparotomy, 8 patients had intra-abdominal injuries and underwent sufficient laparoscopic treatment. The percentage of so called "negative" exploratory laparotomies within this study was 13.2 %. Our analysis suggests that laparoscopy should become firmly established in the diagnostic management and, if indicated, in the treatment of blunt abdominal trauma as well.     

Therapeutic laparoscopy for abdominal trauma

Background: Instead of open laparotomy, laparoscopy can be used safely and effectively for the diagnosis and treatment of traumatic abdominal injuries. Methods: Between February 1998 and January 2002, 78 hemodynamically stable patients (49 males and 29 females) with suspicious abdominal injuries underwent diagnostic or therapeutic laparoscopy. The patients ranged in age from 15 to 79 years (median, 40.9 years). Of these patients, 52 were evaluated for blunt trauma and 26 had sustained a stab wound. Preoperative evaluation with enhanced abdominal computed tomography (CT) showed some significant injuries in all cases. All of the laparoscopic procedures were performed in the operating room with the patient under general anesthesia. Pneumoperitoneum was established using an open Hasson technique at the umbilicus, and a forward-viewing laparoscope (30°) was inserted. Two additional 5- or 10- and 12-mm trocars were placed in the right and left lateral quadrants for manipulation, retraction, aspiration–irrigation, coagulation, and the like. The abdominal cavity was systemically examined, the hemoperitoneum aspirated, and the lesion causing the bleeding or spillage located. Results: On the basis of the laparoscopic findings, diagnostic laparoscopy was enough for 13 patients, and therapeutic laparoscopy was performed in 65 patients (83%) for gastric wall repair [8], small bowel repair [15], small bowel resection–anastomosis [19], ligation of bleeders in the mesentery and omentum [8], sigmoid colon repair [4], Hartmann's procedure [5] cholecystectomy [2], distal pancreatectomy [2], and splenectomy [2]. Totally laparoscopic procedures were performed in 43 patients, laparoscopically assisted procedures in 20 patients, and hand-assisted laparoscopic surgery in 2 patients. No significant abdominal injuries were missed as a result of laparoscopy, and no conversion to exploratory laparotomy was noted. The mean operation time was 142 min, and the mean hospital stay was 9.8 days. There were three cases of postoperative complications (1 wound infection, 1 paralytic ileus, and 1 atelectasis), but no missed injuries and no mortality. Conclusions: The short-term results from this study suggest that laparoscopy is a safe, feasible, effective procedure for the evaluation and treatment of hemodynamically stable patients with abdominal trauma, and that it can reduce the number of nontherapeutic laparotomies performed.     

The place of laparoscopy in the management of the patients with penetrating abdominal trauma

INTRODUCTION: In patients with an abdominal knife wound, the main problem is to determine whether the abdominal trauma is penetrating. The aim of this work is to study the safety of the laparoscopic approach in the management of abdominal knife trauma. MATERIALS: A laparoscopy was performing in sixty patients. Patients were dispatched in four categories according to the laparoscopic findings. A laparotomy was performed after laparoscopy in case of peritoneal tear. RESULTS: Unnecessary laparotomy was avoided in 58% of the patients. The follow-up was favourable with nil mortality and a low morbidity (3%). CONCLUSION: Laparoscopic management of abdominal wound knife trauma is a reliable approach to identify a peritoneum tear. This specific situation requires a laparotomy to look for an intra abdominal tear.     

The role of laparoscopy in penetrating abdominal trauma.

BACKGROUND: Minimally invasive surgery has become increasingly utilized in the trauma setting. When properly applied, it offers several advantages, including reduced morbidity, lower rates of negative laparotomy, and shortened length of hospital stay. The purpose of this study was to evaluate the role of laparoscopy in the management of trauma patients with penetrating abdominal injuries. METHODS: We conducted a 3-year retrospective chart review of 4541 trauma patients admitted to our urban Level II trauma center. Penetrating abdominal injuries accounted for 209 of these admissions. Patients were divided into 3 treatment groups based on the characteristics of their abdominal injuries. Management was either observation, immediate laparotomy, or screening laparoscopy. RESULTS: Thirty-three patients were observed in the Emergency Department based on their initial physical examination and radiologic studies. After Emergency Department evaluation, 154 patients underwent immediate laparotomy. In this group, 119 therapeutic laparotomies, 11 nontherapeutic laparotomies, and 24 negative laparotomies were performed. A review of the negative laparotomies revealed that possibly 8 of 10 gun shot wounds and all 14 stab wounds could have been done laparoscopically. Twenty-two patients underwent laparoscopic evaluation, 9 of which were converted to open procedures. CONCLUSION: Minimally invasive surgical techniques are particularly helpful as a screening tool for anterior abdominal wall wounds and lower chest injuries to rule out peritoneal penetration. Increased use of laparoscopy in select patients with penetrating abdominal trauma will decrease the rate of negative and nontherapeutic laparotomies, thus lowering morbidity and decreasing length of hospitalization. As technology and expertise among surgeons continues to improve, more therapeutic intervention may be done laparoscopically in the future.     

腹腔镜在腹部闭合性损伤中的应用

目的探讨腹腔镜在腹部闭合性损伤中的应用. 方法 2000年7月～2003年12月我院对21例血流动力学稳定的腹部闭合性损伤急诊行腹腔镜探查及治疗. 结果 21例均在腹腔镜下明确诊断.开腹肝修补术4例,腹腔镜肝修补术2例,开腹脾切除术5例,手助腹腔镜脾切除术3例,腹腔镜辅助下小切口小肠修补术2例,小肠部分切除术4例,腹腔镜大网膜血管缝扎止血1例. 结论腹腔镜诊治腹部闭合性外伤准确、安全、有效.     

The role of video-assisted laparoscopy in management of patients with small bowel injuries in abdominal trauma

Background  Patients with small bowel injuries (SBI) in abdominal trauma have no clear clinical or radiological signs on initial examination. This leads to delay in appropriate surgical interventions with consequent high morbidity and mortality. In this paper we demonstrate the role of video-assisted laparoscopy (VAL) in management of such patients. Methods and materials  819 patients with SBI were evaluated retrospectively between 1994 and 2003. The mechanism of the trauma was blunt in 146 (17.8%) patients and stab wounds in 640; routine investigations and VAL were used for triage of the subjects. All the victims underwent laparotomy or video-assisted laparoscopy. Demographic information, incidence of organs injuries, types of surgery, complications, associated injuries, and hospital mortality were analyzed. Results  Diagnostic video laparoscopy was sufficient for 518 (63.2%) patients. Small bowel repair was performed in 332 (40.6%) patients, clipping of mesenteric blood vessels in 27 (3.4%) patients, and coagulation and ligation of omental blood vessels in 48 (5.9%) patients. Ninety-seven (11.8%) patients with small bowel injury were associated with postoperative complications. There were 19 (2.3%) deaths associated with hemoperitoneum, severe head injury, and multiple ribs fracture. Generalized peritonitis was revealed in one case and focal abscesses between intestinal loops were identified in another one patient. Conclusion  The DVAL findings of visceral injuries give optimal approach for management of small bowel injuries in abdominal trauma.     

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。     

腹腔镜技术在脾脏外伤治疗中的价值

目的 探讨腹腔镜技术在脾脏外伤治疗中的价值。方法 回顾性分析郑州市第二人民医院2012年2月至2018年4月收治的外伤性脾破裂42例行腹腔镜探查及治疗的临床资料。结果 28例腹腔镜探查后保脾成功,6例行腹腔镜下部分脾脏切除术,2例行腹腔镜下脾脏切除术,6例中转行开腹脾切除术。无死亡病例,随访6个月～2年无迟发性脾破裂和凶险性感染发生。结论 对于脾脏损伤患者在充分术前准备的条件下采取腹腔镜探查及治疗,手术风险小、保脾成功率高、术后并发症少、恢复快,值得临床推广应用。     

腹腔镜下治疗肝脾外伤的探讨

目的：探讨腹腔镜下治疗肝脾外伤的可行性及指征。方法：10例肝外伤，1例脾外伤，在腹腔镜下探查后对适合镜下治疗的肝脾外伤采用冲洗、电灼、填塞、缝合修补、引流。结果：5例I－Ⅱ级肝外伤，1例Ⅱ级脾外伤于术后5天拔管出院。结论：I－Ⅱ级肝脾外伤镜下治疗安全可靠。     

Emergency laparoscopy in the diagnosis of closed abdominal trauma

Analysed were the 242 case records of the sufferers treated for closed abdominal trauma. In 80, the laparocentesis was performed with the use of the "seeking catheter", in 78--combined laparoscopy. The indications for the performance of these diagnostic manipulations are substantiated, their diagnostic informative value is assessed.     

47例闭合性腹部外伤腹腔镜手术的临床应用

目的:探讨腹腔镜手术在闭合性腹外伤中的诊治价值。方法:回顾分析2003年12月至2006年7月施行急诊腹腔镜手术的临床资料。结果:47例经腹腔镜均于术中明确诊断,腹腔镜下完成28例,17例中转开腹,2例无需处理。均治愈出院,无手术死亡和并发症发生。结论:腹腔镜手术诊断闭合性腹部外伤准确率高,可使患者得到及时、有效、合理的治疗。