Zhao Jasmine, Samaan Jamil S, Toubat Omar, Samakar Kamran
Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California.
J Surg Res. 2020 Aug;252:222-230. doi: 10.1016/j.jss.2020.03.013. Epub 2020 Apr 11.
Investigate the diagnostic and therapeutic utility of laparoscopy in the management of patients with chronic abdominal pain of unknown origin.
Ovid MEDLINE, PubMed, and SCOPUS databases were queried to identify relevant published studies. Data on the diagnostic and therapeutic utility of laparoscopy were abstracted and summarized.
Laparoscopy achieved a diagnosis in 65% to 94% of patients with chronic abdominal pain of unknown origin. Common intraoperative findings included adhesions, chronic appendicitis, hernias, and enlarged mesenteric lymph nodes. These findings corresponded with the therapeutic procedures that were performed, including laparoscopic adhesiolysis, appendectomy, and hernia repair. Therapeutic utility of laparoscopy based on pain relief, patient satisfaction, and quality of life ranged from 63% to 94%.
Based on current available evidence, diagnostic laparoscopy (DL) is a safe and effective method for identifying organic causes of chronic abdominal pain. Laparoscopic treatment also resulted in substantial pain relief for a majority of patients. However, the efficacy of laparoscopic adhesiolysis remains controversial. We would recommend the use of DL as an early diagnostic tool, but more robust studies are needed to establish the breadth of its therapeutic utility in clinical practice.
探讨腹腔镜检查在不明原因慢性腹痛患者管理中的诊断和治疗作用。
检索Ovid MEDLINE、PubMed和SCOPUS数据库以识别相关已发表研究。提取并总结关于腹腔镜检查诊断和治疗作用的数据。
腹腔镜检查在65%至94%的不明原因慢性腹痛患者中实现了诊断。常见术中发现包括粘连、慢性阑尾炎、疝气和肠系膜淋巴结肿大。这些发现与所实施的治疗程序相对应，包括腹腔镜粘连松解术、阑尾切除术和疝气修补术。基于疼痛缓解、患者满意度和生活质量的腹腔镜检查治疗作用范围为63%至94%。
基于现有证据，诊断性腹腔镜检查（DL）是识别慢性腹痛器质性病因的一种安全有效的方法。腹腔镜治疗也使大多数患者的疼痛得到显著缓解。然而，腹腔镜粘连松解术的疗效仍存在争议。我们建议将DL用作早期诊断工具，但需要更有力的研究来确定其在临床实践中的治疗作用范围。
