Agresta F, Michelet I, Coluci G, Bedin N
Department of Surgery, Ospedale Civile di Vittorio Veneto, Via Forlanini, 71, 31029 Vittorio Veneto (TV), Italy.
Surg Endosc. 2000 May;14(5):484-7. doi: 10.1007/s004640000022.
By now, laparoscopic surgery has achieved widespread acceptance among surgeons and, generally speaking, by the public. Therefore, we set out to evaluate whether this technique is a feasible method of treating patients with abdominal emergencies, traumatic or not. To assess the routine use of emergency laparoscopy in a community hospital setting, we undertook a retrospective analysis of an unrandomized experience (presence or absence of a surgeon with laparoscopic experience).
Between January 1993 and October 1998, 575 emergency abdominal surgical procedures were done in our department. In all, 365 (63.4%) were diagnostic and operative laparoscopy procedures (acute small bowel obstruction: 23 cases; hernia disease: one case; gastroduodenal ulcer disease: 15 cases; biliary system disease: 89 cases; pelvic disease: 237 cases). These cases represent almost 56% of all laparoscopic procedures done during the same period at our institution. Laparoscopy was not performed in patients with a history of a previous abdominal approach to malignant disease, a history of more than two major abdominal surgeries, or massive bowel distension; nor was it used in patients whose general conditions contraindicate this approach.
The conversion rate was 6.8%. The morbidity and mortality rates were, respectively, 4.1% and 0.8%. A definitive diagnosis was provided in 95.3% of cases, with the possibility to treat 88.2% of them by laparoscopy.
We consider the laparoscopic approach in patients with abdominal emergencies to be feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities. Sparing patients laparotomy reduces postoperative pain, improves recovery of GI function, reduces hospitalization, cuts health care costs, and improves cosmetic results. This approach promises to play a significant role in emergency abdominal situations and will certainly become increasingly important in today's health care environment.
目前，腹腔镜手术已被外科医生广泛接受，并且总体而言也得到了公众的认可。因此，我们着手评估该技术是否是治疗腹部急症患者（无论是否为创伤性）的可行方法。为了评估在社区医院环境中急诊腹腔镜检查的常规应用情况，我们对一项非随机经验（有无腹腔镜经验的外科医生）进行了回顾性分析。
1993年1月至1998年10月期间，我们科室共进行了575例急诊腹部外科手术。其中，365例（63.4%）为诊断性和手术性腹腔镜检查手术（急性小肠梗阻：23例；疝疾病：1例；胃十二指肠溃疡疾病：15例；胆道系统疾病：89例；盆腔疾病：237例）。这些病例几乎占我们机构同期所有腹腔镜手术的56%。有腹部恶性疾病既往手术史、超过两次重大腹部手术史或严重肠扩张的患者未进行腹腔镜检查；一般情况禁忌该方法的患者也未使用。
中转开腹率为6.8%。发病率和死亡率分别为4.1%和0.8%。95.3%的病例得到了明确诊断，其中88.2%的病例可通过腹腔镜进行治疗。
我们认为，在有经验的医生手中，对腹部急症患者采用腹腔镜手术方法是可行且安全的。它提供了诊断准确性以及治疗能力。避免患者开腹可减轻术后疼痛，改善胃肠功能恢复，减少住院时间，降低医疗费用，并改善美容效果。这种方法有望在腹部急症情况中发挥重要作用，并且在当今的医疗环境中肯定会变得越来越重要。
