Ou C S, Rowbotham R
Department of Gynecology, University of Washington School of Medicine and Northwest Hospital, Seattle, USA.
J Laparoendosc Adv Surg Tech A. 2000 Feb;10(1):41-5. doi: 10.1089/lap.2000.10.41.
We reviewed the records of 77 women treated for nontraumatic acute abdomen by the principal author between June 1991 and June 1996. All patients presented to either the surgeon's office or the emergency room at Northwest Hospital, which is an urban community hospital in North Seattle. Our objectives in the study were to determine the effectiveness of diagnostic laparoscopy for nontraumatic acute abdomen and the percentage of cases managed using laparoscopic technique exclusively.
The mean patient age was 36.5 (range 12-65) years. The majority of these women (92%) were premenopausal. Seventy-two (93.5%) were Caucasian, and the remaining 5 (6.5%) were Asian. Thirty-eight of the women (49%) had undergone at least one prior pelvic or abdominal operation, and 28 (36%) had undergone more than one. The principal author performed preoperative clinical evaluations, then diagnostic laparoscopy for all 77 patients.
Laparoscopy provided a definitive diagnosis in 76 of the 77 cases. In 70% of the cases (54 of 77) the preoperative diagnosis was confirmed by diagnostic laparoscopy, and in 29% (22 of 77), the diagnosis was confirmed, yet augmented or clarified, by diagnostic laparoscopy. In the remaining case, diagnostic laparoscopy ruled out any acute etiology. Ninety-five percent of the patients (72 of 76) were treated exclusively by laparoscopy (70 cases) or a laparoscopy-assisted procedure (2 cases). Four patients (5%) required conversion to laparotomy. The remaining patient required no therapeutic surgery. Mortality was 0 and morbidity 4%.
A high proportion of women presenting with acute abdominal pain can be managed using a laparoscopic technique exclusively.
我们回顾了1991年6月至1996年6月期间由第一作者治疗的77例非创伤性急腹症女性患者的病历。所有患者均前往西北医院的外科办公室或急诊室就诊，该医院是西雅图北部的一家城市社区医院。我们这项研究的目的是确定诊断性腹腔镜检查对非创伤性急腹症的有效性以及仅采用腹腔镜技术处理的病例百分比。
患者的平均年龄为36.5岁（范围12 - 65岁）。这些女性中的大多数（92%）处于绝经前。72名（93.5%）为白种人，其余5名（6.5%）为亚洲人。38名女性（49%）此前至少接受过一次盆腔或腹部手术，28名（36%）接受过不止一次此类手术。第一作者进行了术前临床评估，然后对所有77例患者进行了诊断性腹腔镜检查。
77例病例中有76例通过腹腔镜检查得到了明确诊断。在70%的病例（77例中的54例）中，术前诊断通过诊断性腹腔镜检查得到证实，在29%（77例中的22例）中，诊断得到证实，但通过诊断性腹腔镜检查得到了补充或明确。在其余病例中，诊断性腹腔镜检查排除了任何急性病因。95%的患者（76例中的72例）仅通过腹腔镜检查（70例）或腹腔镜辅助手术（2例）进行治疗。4例患者（5%）需要转为开腹手术。其余患者无需进行治疗性手术。死亡率为0，发病率为4%。
很大一部分出现急性腹痛的女性可以仅通过腹腔镜技术进行处理。
