腹腔镜技术在胃肠外科急腹症中的应用

目的探讨腹腔镜技术在腹部外科急腹症诊断和治疗中的应用。方法回顾性分析2008年10月至2011年10月问解放军总医院普通外科收治的因诊断不明确而接受腹腔镜探查术44例急腹症患者的临床资料。并与同期行急诊剖腹探查术的65例患者资料进行比较分析。结果经腹腔镜探查的44例患者中，有42例患者（95．5％，42／44）在腹腔镜下明确诊断，其中34例（77．3％）患者在明确诊断的同时于腹腔镜下完成手术治疗，全腔镜下处理20例，小切口辅助14例。与传统剖腹探查术患者相比，腹腔镜探查术手术切口长度明显缩短[（6．7±2．2）cm比（15．8±3．4）cm]、术中出血明显减少[（51．4±303）ml比（117．9±49．5）m1]、术后胃肠功能恢复明显加快[术后进食时间（15．0±6．1）d比（30．5±8.4）d]和术后住院时间明显缩短[（5．6±4．2）d比（8．4±4．8）d]，差异均具有统计学意义（均P〈O．05），而且手术费用也并未见明显增加[（1．2±0．8）万元比（1．4±0．5）万元，P〉O．05]。结论腹腔镜探杏技术在腹部外科急腹症患者中的应用安全、有效．可在明确病因的同时实施治疗。

Application of laparoscopic technique in acute abdomen of gastrointestinal surgery

Objective To explore the clinical application of laparoscopy in gastrointestinal abdominal emergency. Methods Clinical data of 44 cases with undefined acute abdomen undergoing laparoscopie surgery from October 2008 to October 2011 were analyzed retrospectively. Sixty-five cases treated by regular surgery during the same period were enrolled as controls. Results In laparoscopic surgery group, 42 cases were diagnosed under laparoscopy（95.5%, 42/44）. Thirty-four （77.3%,34/44） patients received operation successfully after diagnosis, including 20 of total laparoscopy, 14 of assistant small incision. Compared with control group, laparoscopic group had shorter length of incision[（6.7＋2.2） cm vs. （15.8±3.4） cm], less blood loss[（51.4±30.3） ml vs. （117.9±49.5） ml], faster recovery of postoperative gastrointestinal function [postoperative oral intake （ 15.0 ±6.1 ） d vs. （30.5±8.4） d], shorter hospital stay[（5.6±4.2） d vs. （8.4±4.8） d] （all P〈0.05）, lower eomplication rate, and less surgical cost （P〉0.05）. Conclusion Laparoscopy is safe and effeetive in treating gastrointestinal abdominal emergency and therapeutic operation ean be performed after a definite diagnosis.