Hoshino Nobuaki, Endo Hideki, Hida Koya, Kumamaru Hiraku, Hasegawa Hiroshi, Ishigame Teruhide, Kitagawa Yuko, Kakeji Yoshihiro, Miyata Hiroaki, Sakai Yoshiharu
Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan.
Department of Healthcare Quality Assessment Tokyo University Graduate School of Medicine Tokyo Japan.
Ann Gastroenterol Surg. 2021 Dec 13;6(3):430-444. doi: 10.1002/ags3.12533. eCollection 2022 May.
Elective laparoscopic surgery is now widely accepted in the treatment of abdominal diseases because of its minimal invasiveness and rapid postoperative recovery. It is also used in the emergency setting for the diagnosis and treatment of acute diffuse peritonitis regardless of the causative disease. However, the value of laparoscopy in acute diffuse peritonitis remains unclear. In this study we aimed to show trends in the use of laparoscopy over time and compare the real-world performance of laparoscopic surgery with that of open surgery for acute diffuse peritonitis due to gastrointestinal perforation.
We extracted data from the National Clinical Database, a nationwide surgery registration system in Japan, for patients with a diagnosis of acute diffuse peritonitis due to gastroduodenal or colorectal perforation between 2016 and 2019. Trends in the use of laparoscopy over time were identified. Patient characteristics, laboratory findings, surgical findings, and postoperative complications were compared between laparoscopic surgery and open surgery.
Patients in poor condition and those with abnormal laboratory findings tended to undergo open surgery. Anesthesia time and operating time were longer for laparoscopic surgery in patients with gastroduodenal perforation but shorter in those with colorectal perforation. Fewer complications occurred in patients who underwent laparoscopic surgery. The number of institutions where laparoscopic surgery was performed and the proportion of the use of laparoscopy at each institution increased over time.
The use of laparoscopy is becoming common in surgery for acute diffuse peritonitis due to gastrointestinal perforation. This approach may be a useful option for acute diffuse peritonitis.
选择性腹腔镜手术因其微创性和术后恢复快，目前在腹部疾病治疗中已被广泛接受。它也被用于急诊情况，用于诊断和治疗急性弥漫性腹膜炎，而不考虑病因。然而，腹腔镜在急性弥漫性腹膜炎中的价值仍不明确。在本研究中，我们旨在展示腹腔镜手术随时间的使用趋势，并比较腹腔镜手术与开放手术治疗因胃肠道穿孔引起的急性弥漫性腹膜炎的实际效果。
我们从日本全国性的手术登记系统——国家临床数据库中提取了2016年至2019年间诊断为因胃十二指肠或结肠穿孔导致急性弥漫性腹膜炎患者的数据。确定了腹腔镜手术随时间的使用趋势。比较了腹腔镜手术和开放手术患者的特征、实验室检查结果、手术发现和术后并发症。
病情较差和实验室检查结果异常的患者倾向于接受开放手术。胃十二指肠穿孔患者腹腔镜手术的麻醉时间和手术时间较长，但结肠穿孔患者的则较短。接受腹腔镜手术的患者并发症较少。进行腹腔镜手术的机构数量以及每个机构腹腔镜手术的使用比例随时间增加。
腹腔镜手术在因胃肠道穿孔引起的急性弥漫性腹膜炎手术中越来越普遍。这种方法可能是治疗急性弥漫性腹膜炎的一个有用选择。
