Beltzer Christian, Bachmann Robert, Strohäker Jens, Axt Steffen, Schmidt Roland, Küper Markus, Königsrainer Alfred
Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland.
Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
Chirurg. 2020 Jul;91(7):567-575. doi: 10.1007/s00104-020-01158-y.
The range of indications for laparoscopic procedures has been continuously widened in recent years. At the same time, however, the diagnostic and therapeutic role of laparoscopy in the management of blunt and penetrating abdominal trauma remains controversial.
A systematic literature search was carried out in PubMed from 2008 to 2019 on the use of laparoscopy in blunt and penetrating abdominal trauma. Studies were analyzed in terms of relevant operative and perioperative event rates (rate of missed injuries, conversion rate, postoperative complication rate). On the basis of this analysis, an algorithm for the use of laparoscopy in abdominal trauma was developed for clinical practice.
A total of 15 full texts with 5869 patients were found. With a rate of 1.4%, laparoscopically missed injuries were very rare for both penetrating and blunt abdominal trauma. Of all trauma laparoscopies 29.3% were converted to open surgery (laparotomy). Among the non-converted laparoscopies 60.5% were therapeutic. Complications occurred after trauma laparoscopy in 8.6% of cases.
By means of systematic laparoscopic exploration, missed injuries in abdominal trauma are extremely rare, so that concerns in this respect no longer seem justified. A large proportion of intra-abdominal injuries can be treated using laparoscopy or laparoscopically assisted procedures.
近年来，腹腔镜手术的适应证范围不断扩大。然而，与此同时，腹腔镜在钝性和穿透性腹部创伤管理中的诊断和治疗作用仍存在争议。
2008年至2019年在PubMed上对腹腔镜在钝性和穿透性腹部创伤中的应用进行了系统的文献检索。对研究的相关手术和围手术期事件发生率（漏诊率、中转率、术后并发症发生率）进行了分析。在此分析的基础上，制定了腹腔镜在腹部创伤中应用的临床实践算法。
共检索到15篇全文，涉及5869例患者。无论是穿透性还是钝性腹部创伤，腹腔镜漏诊率均极低，为1.4%。在所有创伤性腹腔镜手术中，29.3%中转开腹手术（剖腹术）。在未中转的腹腔镜手术中，60.5%为治疗性手术。创伤性腹腔镜手术后并发症发生率为8.6%。
通过系统的腹腔镜探查，腹部创伤的漏诊极为罕见，因此在这方面的担忧似乎不再合理。大部分腹腔内损伤可通过腹腔镜或腹腔镜辅助手术治疗。
