Decadt B, Sussman L, Lewis M P, Secker A, Cohen L, Rogers C, Patel A, Rhodes M
Norwich NHS Trust Hospital, UK.
Br J Surg. 1999 Nov;86(11):1383-6. doi: 10.1046/j.1365-2168.1999.01239.x.
Abdominal pain of uncertain aetiology (non-specific abdominal pain; NSAP) is the commonest reason for emergency surgical admission. The aim of this study was to examine the role of early laparoscopy in the management of NSAP.
Some 120 patients, admitted between November 1995 and October 1998 with acute abdominal pain of uncertain aetiology, were randomized into two groups: group 1 had laparoscopy during the first 18 h of admission and group 2 had close observation, conventional investigation and surgical intervention if signs of peritonism developed. Outcome measures were diagnosis, operative procedures, duration of hospital stay, readmission rate, morbidity and death, patient satisfaction and total number of investigations performed.
Median hospital stay was 2 (range 1-13) days in both groups (P = 0.87). A diagnosis was established in 48 (81 per cent) of 59 patients in group 1 compared with 22 (36 per cent) of 61 in group 2 (P < 0.0001). The morbidity rate was 14 (24 per cent) of 59 in group 1 and 19 (31 per cent) of 61 in group 2 (P = 0.3629). The readmission rate at a median follow-up of 21 (range 1-35) months was 17 (29 per cent) of 59 in group 1 compared with 20 (33 per cent) of 61 in group 2 (P = 0. 6375). Well-being scores improved from 134 on admission to 149 of 177 6 weeks later in group 1 (P = 0.007) and from 132 to 143 of 177 in group 2 (P = 0.089).
Early laparoscopy provided a higher diagnostic accuracy and improved quality of life in patients with NSAP.
病因不明的腹痛（非特异性腹痛；NSAP）是急诊手术入院最常见的原因。本研究的目的是探讨早期腹腔镜检查在NSAP治疗中的作用。
1995年11月至1998年10月期间，约120例因病因不明的急性腹痛入院的患者被随机分为两组：第1组在入院后18小时内行腹腔镜检查，第2组进行密切观察、常规检查，若出现腹膜炎体征则进行手术干预。观察指标包括诊断结果、手术操作、住院时间、再入院率、发病率和死亡率、患者满意度以及所进行检查的总数。
两组的中位住院时间均为2天（范围1 - 13天）（P = 0.87）。第1组59例患者中有48例（81%）确诊，而第2组61例患者中有22例（36%）确诊（P < 0.0001）。第1组59例患者中的14例（24%）发生并发症，第2组61例患者中的19例（31%）发生并发症（P = 0.3629）。在中位随访21个月（范围1 - 35个月）时，第1组59例患者中的17例（29%）再次入院，第2组61例患者中的20例（33%）再次入院（P = 0.6375）。第1组患者的健康状况评分从入院时的134分提高到6周后的177例中的149分（P = 0.007），第2组从132分提高到177例中的143分（P = 0.089）。
早期腹腔镜检查可提高NSAP患者的诊断准确性并改善生活质量。
