腹腔镜检查用于不明原因发热的处理
Laparoscopic approach to fever of unknown origin.
作者信息
Arch-Ferrer J E, Velázquez-Fernández D, Sierra-Madero J, López-Karpovitch X, Angeles-Angeles A, Gamino R, Herrera M F
机构信息
Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan 14000, México, DF Mexico.
出版信息
Surg Endosc. 2003 Mar;17(3):494-7. doi: 10.1007/s00464-002-8589-0. Epub 2002 Nov 20.
BACKGROUND
Fever of unknown origin (FUO) is difficult to diagnose. Laparotomy is needed to establish the etiologic diagnosis in some patients. The aim of this study was to analyze the feasibility, safety, and success rate of a protocolized laparoscopy in patients with FUO.
METHODS
An extensive clinical evaluation was performed before surgery. Laparoscopy included inspection of the abdominal cavity, wedge and tru-cut liver biopsies, lymph node biopsy, splenectomy, and bone marrow biopsy. Histologic analysis, permanent section analysis, and cultures were obtained.
RESULTS
The study involved 15 patients with a mean age of 43.6 +/- 14.5 years. The mean operative time was 122 +/- 60 min. Minor complications occurred in 9% of the patients. One patient bled after surgery and underwent reoperation. There was no operative mortality. An etiologic diagnosis was made in 66% of the patients, and laparoscopy helped to rule out intraabdominal pathology in four additional patients, giving a total success rate of 93%.
CONCLUSION
Protocolized laparoscopy in patients with FUO is safe, feasible, and accurate.
背景
不明原因发热（FUO）难以诊断。在一些患者中需要进行剖腹手术以确立病因诊断。本研究的目的是分析针对FUO患者的标准化腹腔镜检查的可行性、安全性和成功率。
方法
术前进行了全面的临床评估。腹腔镜检查包括腹腔检查、楔形及切割针肝活检、淋巴结活检、脾切除术和骨髓活检。进行了组织学分析、永久切片分析及培养。
结果
该研究纳入了15例患者，平均年龄为43.6±14.5岁。平均手术时间为122±60分钟。9%的患者出现轻微并发症。1例患者术后出血并接受了再次手术。无手术死亡病例。66%的患者获得了病因诊断，腹腔镜检查还帮助另外4例患者排除了腹内病变，总成功率为93%。
结论
针对FUO患者的标准化腹腔镜检查是安全、可行且准确的。
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