Sugarbaker P H, Sanders J H, Bloom B S, Wilson R E
Lancet. 1975 Feb 22;1(7904):442-5. doi: 10.1016/s0140-6736(75)91505-6.
During 1973, 56 patients on one of three general surgical services at the Peter Bent Brigham Hospital, Boston, Massachusetts, who were judged to require hospital admission for acute abdominal pain were dividied into two groups. This division was determined by whether or not the physician responsible thought a definite diagnosis could be established on clinical grounds. 27 patients were thought to have a definite diagnosis and underwent laparotomy without preoperative laparoscopy; at laparotomy, 6 of these patients (22%) had no operable lesion. An additional 29 patients had severe abdominal pain and required observation in hospital. An exact diagnosis could not be clinically established in these patients, and many would in the past have required exploratory laparotomy. These 29 patients underwent laparoscopy resulting in all but 1 (4%) having the presence or absence of intra-abdominal disease requiring operative intervention definitely established. At laparoscopy, diagnosis was made in 18 patients who did not require laparotomy while 11 had disease requiring laparotomy after laparoscopy. No complications resulted from laparoscopy. The difference in the median length of stay and hospital charges resulted in a saving of one and a half days in hospital and $87 when laparoscopy rather than explatory laparotomy determined that acute abdominal pain was caused by a condition not requiring surgical intervention.
1973年期间，马萨诸塞州波士顿市彼得·本特·布里格姆医院三个普通外科科室中的56名因急性腹痛被判定需住院治疗的患者被分为两组。分组依据是负责的医生认为能否基于临床依据确立明确诊断。27名患者被认为有明确诊断，未进行术前腹腔镜检查就接受了剖腹手术；在剖腹手术中，这些患者中有6名（22%）没有可手术的病变。另外29名患者有严重腹痛，需要住院观察。这些患者在临床上无法确立确切诊断，过去很多人需要进行 exploratory laparotomy（原文有误，推测为exploratory laparotomy，即剖腹探查术）。这29名患者接受了腹腔镜检查，结果除1名患者（4%）外，所有患者腹内疾病是否需要手术干预都得以明确。在腹腔镜检查中，18名不需要剖腹手术的患者得到了诊断，而11名患者在腹腔镜检查后有疾病需要进行剖腹手术。腹腔镜检查未导致任何并发症。住院时间中位数和住院费用的差异表明，当通过腹腔镜检查而非剖腹探查术确定急性腹痛是由无需手术干预的情况引起时，可节省一天半的住院时间和87美元。
