腹腔镜与开腹手术诊治急性弥漫性腹膜炎的对比分析

目的:对比腹腔镜手术及开腹手术在急性弥漫性腹膜炎诊断与治疗中的临床疗效。方法:回顾分析2009年9月至2014年9月收治的72例急性弥漫性腹膜炎患者的临床资料,将患者随机分为两组,36例患者行腹腔镜手术(腔镜组),36例患者行开放手术(开腹组),对比两组诊断与治疗的效果。结果:两组患者均于术中明确诊断,确诊率均达100%。腔镜组术中出血量、术后胃肠功能恢复(肛门排气)时间、住院时间、术后切口感染率、肠梗阻发生率均优于开腹组,差异有统计学意义(P0.05)。结论:腹腔镜手术治疗急性弥漫性腹膜炎术中可明确诊断,患者创伤小,术后康复快,在急性弥漫性腹膜炎的诊断与治疗中具有较好的临床应用价值。     

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。     

腹腔镜在急性腹膜炎中的诊治体会

目的探讨腹腔镜在急性腹膜炎中的临床应用。方法回顾性分析应用腹腔镜诊治的75例急性腹膜炎患者的临床资料。结果诊断准确率为100%(75/75)。其中急性阑尾炎29例,消化道穿孔18例,急性盆腔炎6例,较窄性肠梗阻4例,急性肠系膜动脉栓塞2例,脾破裂2例,宫外孕2例,中转开腹手术12例,腔镜下手术成功率81.0%(51/63);原发性腹膜炎6例,结核性腹膜炎4例,急性坏死性肠炎2例,保守治疗痊愈。全组均无严重并发症出现。结论腹腔镜诊治不明原因的急性腹膜炎具有诊断准确率高,并能对大部分疾病直接进行微创治疗,避免不必要的开腹手术等优点,值得临床推广应用。     

急性腹膜炎腹腔镜手术与开腹手术的对比研究

目的:探讨急性腹膜炎腹腔镜手术与开腹手术的临床效果.方法:回顾分析2005年1月至2011年1月为332例急性腹膜炎患者施行腹腔镜手术的临床资料,同期为253例急性腹膜炎患者施行开腹手术,并对比分析两组手术时间、术后下床时间、通气时间、住院时间、止痛剂使用、粘连性肠梗阻发生例数等.结果:两组均无相关脏器损伤等并发症发生...     

腹腔镜诊治急腹症7例报告

目的:探讨腹腔镜诊治急腹症的价值。方法:回顾分析7例急腹症患者施行腹腔镜手术的临床资料。结果:7例患者,包括1例急性胆囊炎,2例急性阑尾炎,2例急性粘连性肠梗阻及2例术后出血患者均在腹腔镜下行相应手术,无1例中转开腹,术后无并发症发生。结论:急腹症患者行腹腔镜手术具有确诊兼治疗的作用,患者术后康复快,住院时间短。     

腹腔镜手术治疗急性阑尾炎72例报告

目的探讨腹腔镜手术治疗急性阑尾炎的价值. 方法对54例急性化脓性阑尾炎、18例阑尾炎穿孔并腹膜炎行腹腔镜手术治疗,并与同期72例阑尾炎开放手术比较. 结果腹腔镜组的并发症发生率、肠功能恢复时间及平均住院日分别为0,0.5 d,2.3 d,对照组分别为15%,2.5 d,6.8 d,两组比较有显著差异. 结论与开放手术比较,腹腔镜治疗急性化脓性阑尾炎及阑尾穿孔性腹膜炎有并发症少,术后恢复快的优势.     

经剖宫产术后腹壁瘢痕做切口行腹腔镜手术治疗急性阑尾炎

目的:总结经剖宫产术后腹壁瘢痕做切口行腹腔镜手术治疗急性阑尾炎的临床经验。方法:回顾分析2005年12月至2008年7月我院实施的经剖宫产术后腹壁瘢痕做切口行腹腔镜手术治疗急性阑尾炎36例患者的临床资料。结果:36例均顺利完成腹腔镜手术,无中转开腹。2例术中探查证实为黄体破裂,行电凝止血术;1例右侧输卵管积脓伴盆腔炎,行患侧输卵管切除加盆腔冲洗。无术后出血、感染等并发症发生。结论:经剖宫产术后腹壁瘢痕做切口行腹腔镜手术治疗急性阑尾炎安全可行,不增加明显手术瘢痕,具有美容效果。对育龄妇女的右下腹痛,阑尾炎诊断可疑者,腹腔镜可以明确诊断并确切治疗。     

腹腔镜技术在急性化脓性腹膜炎诊断和治疗中的作用

目的 探讨腹腔镜技术在急性化脓性腹膜炎中诊断和治疗的作用。方法 对104例化脓性腹膜炎患者实施腹腔镜探查，对腹腔镜手术实施率、诊断正确率、治愈率、中转手术率进行回顾性分析。结果 腹腔镜手术实施率95．2％，腹腔镜术中诊断正确率为98．1％，诊断与治疗可经腹腔镜一次操作完成，治愈率97．9％，中转开腹率4．8％。结论 腹腔镜技术运用于急性化脓性腹膜炎诊断和治疗是可行、安全、有效的，具有诊断正确率高、损伤小、术中探查范围广等优点；腹腔镜手术在急腹症中目前尚不能完全取代开腹探查手术。     

腹腔镜胆囊大部切除术治疗急性化脓性胆囊炎

目的探讨急性化脓性胆囊炎行腹腔镜胆囊大部切除术的可行性及疗效。方法回顾性总结37例急性化脓性胆囊炎患者行腹腔镜胆囊大部切除术的临床资料。结果本组37例均成功行腹腔镜胆囊大部切除术,无中转开腹。术后因肝肾功能衰竭死亡2例,腹膜炎中毒性休克死亡1例;发生胆汁漏4例,均在1周之内经保守治疗痊愈。结论特殊情况下行腹腔镜胆囊大部切除术治疗急性化脓性胆囊疾病是安全可行的,有一定的临床价值。     

腹腔镜开窗式胆囊大部切除术的临床应用

目的:探讨腹腔镜开窗式胆囊大部切除术治疗急性胆囊炎的临床应用。方法:回顾分析2010年12月至2017年12月为23例急性胆囊炎行胆囊切除困难的患者行腹腔镜开窗式胆囊大部切除术的临床资料。结果:23例手术均顺利完成,无一例中转开腹,手术时间平均(62±11)min,术中出血量平均(85±25)mL,术后排气时间平均(23.5±2.6)h;术后6 h饮水,24 h进食;无腹腔出血、肠管损伤、肝外胆管损伤、胆汁性腹膜炎等并发症发生;术后5～7 d痊愈出院。随访4～48个月,术前临床症状消失,饮食正常。结论:急性期胆囊炎患者行腹腔镜开窗式胆囊大部切除术可避免强行解剖胆囊三角,减少胆管、血管损伤等并发症的发生,手术安全、可行,是治疗急性胆囊炎及复杂困难型胆囊的有效术式。     

Perforated appendicitis: is laparoscopic operation advisable?

AIMS: A retrospective study was used to compare laparoscopic appendectomy for perforated appendicitis to open operation. METHODS: Between July 1991 and June 1999 a total of 734 patients, all over 14 years of age, underwent operation for acute appendicitis. Of these patients, 125 (17%) displayed perforated appendicitis and were treated with either a laparoscopic appendectomy (n = 80; total conversion rate 36/80, 45%) or a primary open procedure (n = 45). RESULTS: Due to selection, the 3 treatment groups (laparoscopic, laparoscopy with conversion, open operation) showed differences with respect to gender, duration of symptoms, proportion of obese patients and patients with generalized peritonitis. The median operating time was 75 min for the laparoscopic procedure, 90 min for a converted procedure and 70 min for open operation. Only 1 of 44 (2%) patients who had a laparoscopic operation, but 8 of 36 (22%) who had a converted operation, and 8 of 45 (18%) who had an open operation developed wound infection. A similar frequency of intra-abdominal abscess formation was observed in the 3 treatment groups (2/44, 5%; 3/36, 8%; 2/45, 5%). Fatal outcome occurred only in patients who underwent an open operation and presented with severe peritonitis (5/45, 11%). CONCLUSIONS: Despite limitations in comparability of patient groups, laparoscopic appendectomy was associated with a significantly lower rate of septic wound complications (p < 0.05). This was especially true for the subgroup of obese patients (BMI >26). Therefore, for patients with perityphlitic abscess or fresh purulent lower abdominal peritonitis, but not for patients with generalized peritonitis, laparoscopic appendectomy is not only justifiable but even recommended as the procedure of choice.     

The role of laparoscopy in patients with suspected peritonitis: experience of a single institution

PURPOSE: In this report, we retrospectively evaluate the effect of a laparoscopic approach in the diagnosis and treatment of acute abdominal pain in patients with suspected peritonitis. PATIENTS AND METHODS: We evaluated the clinical records of patients admitted to our institution between January 1995 and July 2001 with a diagnosis of acute abdomen and suspected peritonitis. RESULTS: Ninety four of 229 patients underwent diagnostic laparoscopy. In this series, 83 (88.3%) of the cases were successfully treated by emergent laparoscopy for an acute abdomen. Eleven (11.7%) required conversion to an open laparotomy procedure. Overall, the preoperative diagnosis was confirmed by laparoscopy in 67 (71.27%) of the cases. It was not confirmed in 27 (28.73%). Postoperative mortality was 4.25%. Morbidity was 8.5%. DISCUSSION: Data reported in the literature establish that laparoscopy offers adequate visualization of the entire abdomen and pelvic cavity in the diagnosis of an abdomen acute secondary to peritonitis. In this series, laparoscopy confirmed the diagnosis in 97.8% of the patients, and minimally invasive treatment was achieved in 88.3% of the cases. Female patients with gynecologic disease particularly benefitted from a laparoscopic approach, which permitted the correct evaluation of this condition and may have prevented unnecessary laparotomy. We believe that laparoscopy is an accurate modality for the diagnosis and treatment of patients with an acute abdomen and suspected peritonitis when the diagnosis cannot be clearly made by physical examination and noninvasive methods.     

腹腔镜胆囊切除术中消化道损伤原因及对策

目的;探讨腹腔镜胆囊切除术（Laparoscopic Cholecystectomy,LC)中消化道损伤的原因,预防措施及处理方法。方法：回顾分析1991年9月－2001年9月我院10000例LC术中消化道损伤的原因及处理方法。探讨其预防措施及处理成功的经验。结果;本组病例共5例消化道损伤（占0．05％）,其中胃窦部损伤,十二指肠球部损伤及回肠损伤各1例,空肠损伤2例。术中发现3例,当即中转开腹行损伤脏器修补术,术后18小时及5天因急性腹膜炎发现各1例,再次剖腹探查行损伤脏器修补及腹腔引流术。全部患者均痊愈出院,无严重并发症出现。结论：LC术中气腹针盲穿,锐利器械暴力插入腹腔盲区,电凝钩反弹是致消化道损伤的主要原因;LC术后出现急性弥漫性腹膜炎症状,考虑到消化道损伤并恰当处理是改善患者预后的关键。     

Appendectomies by celioscopy. Results in 78 patients]

The recent development of laparoscopic surgery has included the treatment of acute appendicitis. We report our results after three years' experience of this type of surgery. We have operated on 78 patients (54 men, 44 women) mean age 28.9 years, suspected of varying degrees of acute appendicitis. The operation was completely carried out by laparoscopy on 71 occasions, including treatment of an abscess in 4 cases and peritonitis in 4 cases (3 of which were sub-mesocolic and one was generalised). The laparoscopy was transformed into laparotomy in 7 cases, 4 of which were due to difficulties of appendix dissection. Mortality was zero. Four complications occurred: 2 minute infections of the trocar hole, one more severe parietal infection which was a cause of readmission and antibiotic treatment, one "syndrome of the fifth day". In conclusion, laparoscopic appendicectomy appears to be quite feasible in the majority of cases, particularly when the appendix is ectopic, with marked abdominal thickening and peritoneal reaction. The postoperative course is uneventful. The laparoscopic technique is very comfortable for the patient during the postoperative period. This technique is becoming increasingly feasible with the operator's experience, and this appears to us to constitute good training for any form of laparoscopic surgery.     

Laparoscopic appendectomy for acute and recurrent appendicitis: retrospective analysis of a single-group 5-year experience

BACKGROUND AND PURPOSE: Twenty years after the first report of laparoscopic appendectomy (LA), its role in the treatment of appendicitis is still under debate. We report herein a retrospective analysis of our cases of LA in the last 5 years, during which we adopted a policy of an almost uniform laparoscopic approach on a rather selected population composed mainly of women with acute or recurrent lower quadrant abdominal pain. PATIENTS AND METHODS: Laparoscopic appendectomy was performed on 33 male and 98 female patients. The mean age at operation was 25.7+/-11.4 years (range 11-59 years). Acute appendicitis with localized or diffuse peritonitis was present in 34 cases. In the remaining 97 patients, the operation was performed for acute or recurring symptoms of lower quadrant abdominal pain. RESULTS: There were no conversions to open surgery. The operating time was 45+/-17 minutes (range 30-110 minutes). The pathology examination of the removed appendices showed acute appendicitis in 34 cases and chronic inflammation in the remaining 97 patients. In one case, histology revealed a coexisting mucinous carcinoid that extended to the perivisceral fat, and a completion right hemicolectomy was performed. Complications were minor in most cases. Reoperation for deep abdominal abscess or hematoma was required in three cases. The mean hospital stay was 2.59+/-1.58 days (range 24 hours-11 days). CONCLUSION: In our hands, LA has proven to be safe and effective. The laparoscopic operation has significant advantages in terms of lower invasiveness and better diagnostic capability. It is especially useful in women of child-bearing age, in whom it may be considered the procedure of choice.     

Emergency laparoscopic surgery

The laparoscopic approach has represented a major step forward in general and emergency surgery. Its application in the emergency setting still raises a number of concerns that limit its more widespread use. To assess the true scope of laparoscopic surgery in the acute abdominal setting, we retrospectively evaluated our experience. From February 2003 to June 2007, 314 patients underwent an emergency laparoscopic operation, for low abdominal pain (193 patients), acute cholecystitis (78 patients), bowel obstruction (18 patients), diffuse peritonitis (16 patients), blunt abdominal trauma (6 patients), and acute pancreatitis (3 patients). Laparoscopy yielded a good diagnostic definition in all cases. The conversion rate was 16.6% (52 patients). Mean operative time was 63 +/- 29 minutes. The general major morbidity rate was 1.5% (4 patients) and the mortality rate was 0.4% (1 pt.). The laparoscopic approach in patients with abdominal emergencies is a useful tool that yields a reliable diagnostic definition in uncertain cases and allows minimal access treatment of the causative disease in the majority of cases.     

急腹症患者行急诊腹腔镜检查与治疗的临床分析(附364例报告)

目的:探讨急腹症患者行急诊腹腔镜检查与治疗的可行性及应用价值。方法:回顾性分析我院2001年1月至2003年6月收治的364例急腹症患者行急诊腹腔镜检查与手术治疗的临床资料。结果:所有患者入院后早期(6h内)急诊行腹腔镜检查。根据探查所见决定手术方式。其中腹腔镜手术302例,中转手术62例。结论:急腹症患者,各项生命体征平稳能够耐受气腹是急诊腹腔镜探查的适应证,特别对于入院诊断不明确的患者,具有早期诊治,减轻痛苦,缩短住院时间,降低住院费用的优点。     

Two-stage totally minimally invasive approach for acute complicated diverticulitis

OBJECTIVES: Surgical options for acute diverticulitis with peritonitis include Hartmann's procedure or resection and primary anastomosis with or without a stoma. Initial laparoscopic lavage and drainage can control the acute intra-abdominal sepsis to allow for a delayed definitive procedure in nonemergency conditions. Potential advantages include the avoidance of a laparotomy, stoma and local infections at the origin of dehiscence and incisional hernias. We evaluated this approach in a selected group of patients. METHODS: Patients with intra-abdominal pus secondary to diverticular perforation requiring surgery were included in the study. Patients with localized pus amenable to computerized tomography (CT)-guided drainage, faecal peritonitis, severe generalized peritonitis, and those in which the perforation was spontaneously visible were excluded. Standard demographic data, CT findings, intra-operative findings and postoperative outcomes were analysed. RESULTS: Ten patients were suitable for the approach. Mean patient age was 60.2 years. Mean body mass index was 28.2 m2/kg. Mean postoperative stay was 8.5 days and uneventful in all patients. One patient re-presented after 3 weeks with acute peritonitis requiring open sigmoidectomy. Six patients successfully underwent laparoscopic sigmoidectomy with primary anastomosis 2-3 months later. Two patients were not re-operated because of comorbidity and one refused surgery. CONCLUSIONS: A two-stage totally minimally invasive approach may be a safe alternative strategy for selected cases of acute complicated diverticulitis.