Bender J S, Talamini M A
Department of Surgery, Francis Scott Key Medical Center, Baltimore, MD.
Surg Endosc. 1992 Nov-Dec;6(6):302-4. doi: 10.1007/BF02498865.
The diagnosis of intraabdominal sepsis in critically ill intensive-care-unit patients remains a challenge. Diagnostic laparoscopy has been performed in seven such patients following admission for coronary artery bypass surgery, gram-negative sepsis, major burns, pneumonia, myocardial infarction, and post-pneumonectomy. Laparoscopy revealed acalculous cholecystitis in two patients (one removed laparoscopically), gangrenous colon in two, cirrhosis with liver infarction in one, and, in two patients, no pathology. Although five patients died postoperatively, none was related to the laparoscopy. There were no intraoperative complications and no known pathology was missed. Because of its ease and accuracy, diagnostic laparoscopy should be considered in all critically ill patients suspected of harboring intraabdominal pathology. Further studies are needed to fully establish its efficacy and safety.
对于重症监护病房中的危重症患者，腹内脓毒症的诊断仍然是一项挑战。七名此类患者在因冠状动脉搭桥手术、革兰氏阴性脓毒症、大面积烧伤、肺炎、心肌梗死和肺叶切除术后入院后接受了诊断性腹腔镜检查。腹腔镜检查显示，两名患者患有非结石性胆囊炎（其中一名通过腹腔镜切除），两名患者患有坏疽性结肠，一名患者患有肝硬化伴肝梗死，两名患者未发现病理异常。尽管五名患者术后死亡，但均与腹腔镜检查无关。术中无并发症，也未漏诊已知病理情况。由于其简便性和准确性，对于所有怀疑有腹内病变的危重症患者，均应考虑进行诊断性腹腔镜检查。需要进一步研究以充分确定其有效性和安全性。
