Eypasch E, Menningen R, Paul A, Troidl H
Krankenhaus Köln-Merheim, Chirurgische Klinik, Universität zu Köln.
Zentralbl Chir. 1993;118(12):726-32.
While diagnostic laparoscopy is a well established tool, therapeutic laparoscopy for acute abdominal disorders has recently been made possible by video-endoscopic techniques. From July 1989 to April 1992, 243 laparoscopic interventions were carried out in patients with an acute abdomen. After a pilot phase, patients with acute appendicitis were entered into a randomized trial, those with acute cholecystitis were operated within the next day list. Among the 243 operations were 202 appendectomies, 12 closures of perforated peptic ulcers, 4 successful interventions for intestinal obstruction, 4 irrigations for intraabdominal abscesses and 35 further operations, some of which had to be finished as laparotomies. Laparoscopic appendectomy was less painful but technically more difficult. In cases which needed bowel resection for ischemic necrosis or diverticular disease, conversion to open surgery had to be performed. Laparoscopic treatment of acute abdominal disorders including peritonitis can be effective and beneficial in one out of two patients. Adequate surgical training, expertise and respect to the safety of the patient are mandatory. The application of endoscopic suture devices will further enlarge the spectrum of laparoscopic treatment options for the acute abdomen.
虽然诊断性腹腔镜检查是一种成熟的工具，但视频内镜技术最近使急性腹部疾病的治疗性腹腔镜检查成为可能。从1989年7月至1992年4月，对患有急腹症的患者进行了243例腹腔镜手术。经过一个试点阶段后，急性阑尾炎患者进入随机试验，急性胆囊炎患者在次日手术名单中接受手术。在这243例手术中，有202例阑尾切除术、12例穿孔性消化性溃疡闭合术、4例肠梗阻成功干预术、4例腹腔脓肿冲洗术以及35例其他手术，其中一些手术不得不转为开腹手术。腹腔镜阑尾切除术疼痛较轻，但技术上更困难。对于因缺血性坏死或憩室病需要进行肠切除的病例，必须转为开放手术。包括腹膜炎在内的急性腹部疾病的腹腔镜治疗对二分之一的患者可能是有效且有益的。必须有足够的外科培训、专业知识并尊重患者的安全。内镜缝合装置的应用将进一步扩大急性腹部疾病腹腔镜治疗选择的范围。
