Karamanakos Stavros N, Sdralis Elias, Panagiotopoulos Spyros, Kehagias Ioannis
Department of Surgery, School of Medicine, University of Patras, Rion University Hospital, Patras, Greece.
Surg Laparosc Endosc Percutan Tech. 2010 Apr;20(2):119-24. doi: 10.1097/SLE.0b013e3181d87178.
Laparoscopy has been widely accepted among surgeons for the diagnosis and management of acute abdominal conditions. In this study, we aim to evaluate and summarize the experience in laparoscopic procedures, both diagnostic and interventional, for emergency nontraumatic abdominal conditions, in a tertiary academic center.
From June 2005 to June 2009, a total of 1414 patients were subjected to a variety of emergency procedures at the university hospital of Patras and 540 of these patients were managed laparoscopically (38.2%). Indications for operations in the laparoscopic group were abdominal pain mimicking appendicitis in 229 patients (42.4%), acute cholecystitis in 248 patients (45.9%), gastroduodenal perforated ulcer in 14 patients (2.6%), small bowel obstruction in 24 patients (4.4%), and nonspecific abdominal pain in 25 patients (4.6%).
Diagnosis was established in 530 patients (98.2%) and definitive laparoscopic treatment was offered to 514 patients (95.2%). The conversion rate was 2.2%. Total mortality was 1.1% and total morbidity was 7.9%.
Laparoscopic approach to abdominal emergency provides high diagnostic accuracy and therapeutic options. Surgical experience, optimal procedural timing, and appropriate patient selection criteria diminish perioperative mortality and morbidity, and are associated with nominal conversion.
腹腔镜检查已被外科医生广泛接受，用于急性腹部疾病的诊断和治疗。在本研究中，我们旨在评估和总结在一家三级学术中心进行的腹腔镜手术（包括诊断性和介入性）治疗非创伤性腹部急症的经验。
2005年6月至2009年6月，在帕特雷大学医院共有1414例患者接受了各种急诊手术，其中540例患者接受了腹腔镜手术治疗（38.2%）。腹腔镜组的手术指征包括：229例（42.4%）腹痛疑似阑尾炎、248例（45.9%）急性胆囊炎、14例（2.6%）胃十二指肠穿孔性溃疡、24例（4.4%）小肠梗阻以及25例（4.6%）非特异性腹痛。
530例患者（98.2%）确诊，514例患者（95.2%）接受了确定性腹腔镜治疗。中转开腹率为2.2%。总死亡率为1.1%，总发病率为7.9%。
腹腔镜治疗腹部急症具有较高的诊断准确性和治疗选择。手术经验、最佳手术时机以及合适的患者选择标准可降低围手术期死亡率和发病率，并减少中转开腹情况。
