腹腔镜技术在外科急腹症中的应用

目的探讨腹腔镜技术在外科急腹症中的应用价值。方法2002年3月～2007年3月,行306例急诊腹腔镜手术探查与相应治疗。术前诊断急性阑尾炎105例,腹痛原因待查34例,急性胆囊炎、胆囊结石64例,消化道穿孔51例,胆总管结石、急性胆管炎5例,肠梗阻33例,有明确外伤史9例,重症急性胰腺炎5例。结果本组306例全部术中明确诊断,腹腔镜手术成功275例,其中阑尾切除术123例,胆囊切除术57例,消化道穿孔修补术48例,22例肠梗阻中行肠粘连松解13例、小肠复位联合斜疝修补4例、腹腔镜辅助下乙状结肠癌根治直肠前吻合4例、小切口小肠肠段切除端端吻合术1例,胆总管切开取石T管引流术3例,右叶肝破裂修补术2例,脾破裂止血3例,重症急性胰腺炎清创冲洗引流术5例,腹腔镜探查12例（肠系膜挫裂伤2例,腹壁刀刺伤伴大网膜挫伤1例,原发性腹膜炎8例,过敏性紫癜腹型1例）;余31例腹腔镜完成困难而中转开腹。306例随访1～18个月,无术中、术后并发症。结论急诊腹腔镜探查术不仅可以对病因不明的急腹症做出准确诊断,且可同时行腹腔镜手术治疗。即使腹腔镜下不能完成的手术,也可以指导及时开腹,以及采取较为合适的手术切口。

Application of Laparoscopy to Acute Abdominal Pain

Objective To explore the efficacy of laparoscopy in acute abdominal pain. Methods From March 2002 to March 2007, 306 patients with acute abdominal pain were explored and treated by laparoscopy in our hospital. The patients were diagnosed with acute appendicitis in 105 cases, unidentified abdominal pain in 34, acute cholecystitis complicated with cholecystolithiasis in 64, gastrointestinal tract perforation in 51, common bile duct stones complicated with acute eholangitis in 5, intestinal obstruction in 33, and severe acute pancreatitis in 5 ; 9 patients were confirmed as having trauma. Results All the 306 patients were unequivocally diagnosed during the operation. Laparoscopy was successfully completed in 275 cases, including 123 cases of appendectomy, 57 cases of cholecystectomy, 48 cases of gastrointestinal tract perforation neoplasty, 13 cases of enterodialysis, 4 cases of intestinal replacement combined with indirect hernia repair, 4 cases of radical resection of the sigmoid colon with precolon anastomosis, 1 ease of small-incision segmental resection of the small bowel, 3 cases of common bile duct resection and calculus removal, 2 cases of neoplasty for right-lobe hepatorrhexis, 3 cases of haemostasis for splenic rupture, 5 cases of debridement and clysis and drainage for severe acute pancreatitis , and 12 cases of laparoscopic abdominal exploration （2 cases of mesentery contusion and laceration, 1 case of abdominal wall punctured wound with contusion of the greater omentum, 8 case of primary peritonitis, and 1 case of abdomen-type allergic purpura）. The remaining 31 patients were converted to open surgery because of difficulties in laparoscopy. The patients were followed up for 1 to 18 months, during which no one showed intra- or post-operative complications. Conclusions Emergency laparoscopic exploration can not only clarify a diagnosis for acute abdominal pain with unknown causes, but also treat the cases simultaneously. Moreover, it is of great help in guiding abdominal resection and making a suitable operative incision, even if the patients can not be treated by laparoscopy alone.