Golash V, Willson P D
Department of surgery, Sultan Qaboos Hospital, P.O. Box 98, Salalah 211, Oman.
Surg Endosc. 2005 Jul;19(7):882-5. doi: 10.1007/s00464-004-8866-1. Epub 2005 May 12.
Acute abdominal pain is a common cause for presentation to the emergency room and hospital admission. Many of these patients will undergo exploration for suspected appendicitis, but in 20-35% of cases a normal appendix is found. Because of the limited access provided by the gridiron incision, a definitive diagnosis may not be found. Other patients may be treated conservatively and discharged, only to return with recurrent pain or more definitive symptoms of pathology. In patients with acute abdominal pain, early laparoscopy is an accurate means of both making a definitive diagnosis and avoiding a delay in the diagnosis.
We performed a retrospective analysis of 1,320 consecutive patients with acute abdominal pain over a 62-month period. All patients underwent diagnostic laparoscopy within 48 h of admission. We evaluated the initial clinical diagnosis, the laparoscopic diagnosis, and the subsequent outcome in this group of patients. Individuals with abdominal trauma were excluded from the study, and all patients were >12 years of age.
A definitive diagnosis was made in 90% of patients after diagnostic laparoscopy. Laparoscopy changed the clinical diagnosis in 30% of cases. (83%) of patients underwent a laparoscopic operation for management of their condition at the time of diagnosis. In 92 patients (7%), conversion to laparotomy was required to manage their condition. Peritonitis was present in 180 patients; of 110 of them had appendicitis. Twelve patients developed complications related to the diagnostic laparoscopy or the laparoscopic operation, and there was one postoperative death due to a perforated gastric malignancy. Mean operating time was 30 min (range, 17-90).
Early diagnostic laparoscopy and treatment results in the accurate, prompt, and efficient management of acute abdominal pain. This technique reduces the rate of unnecessary laparotomy and right iliac fossa gridiron incisions and increases the diagnostic accuracy in these patients. This treatment method is feasible where facilities are available to accommodate the workload and there are practitioners with the requisite expertise.
急性腹痛是患者前往急诊室就诊及住院的常见原因。许多此类患者会因怀疑阑尾炎而接受探查，但在20% - 35%的病例中阑尾是正常的。由于麦氏切口提供的视野有限，可能无法做出明确诊断。其他患者可能接受保守治疗并出院，结果却带着复发性疼痛或更明确的病理症状再次就诊。对于急性腹痛患者，早期腹腔镜检查是做出明确诊断并避免诊断延误的准确方法。
我们对62个月期间连续收治的1320例急性腹痛患者进行了回顾性分析。所有患者在入院后48小时内接受了诊断性腹腔镜检查。我们评估了该组患者的初始临床诊断、腹腔镜诊断及后续结果。腹部外伤患者被排除在研究之外，所有患者年龄均超过12岁。
诊断性腹腔镜检查后，90%的患者得到了明确诊断。腹腔镜检查使30%的病例临床诊断发生了改变。83%的患者在诊断时接受了腹腔镜手术来治疗其病情。92例患者（7%）需要转为开腹手术来治疗其病情。180例患者存在腹膜炎；其中110例患有阑尾炎。12例患者出现了与诊断性腹腔镜检查或腹腔镜手术相关的并发症，有1例患者因胃恶性肿瘤穿孔术后死亡。平均手术时间为30分钟（范围为17 - 90分钟）。
早期诊断性腹腔镜检查及治疗可实现对急性腹痛的准确、及时且有效的管理。该技术降低了不必要的开腹手术率和右下腹麦氏切口率，并提高了这些患者的诊断准确性。在有设施能够承担工作量且有具备必要专业知识的从业者的情况下，这种治疗方法是可行的。
