Scott H J, Rosin R D
St Mary's Hospital, London, UK.
J R Soc Med. 1993 Dec;86(12):699-701. doi: 10.1177/014107689308601209.
The role of laparoscopy in the management of patients presenting to one surgical firm with an acute abdomen is discussed. Sixty-seven laparoscopies have been performed over an 18 month period and it has altered the diagnosis in 19.4% of cases and the management in 13.4% of cases. At laparoscopy the diagnosis of appendicitis was made in 37 patients (81% had attempted laparoscopic appendicectomies); pelvic inflammatory disease in 15 patients; torted fimbrial cyst in two patients; and free pus in the right lower peritoneum as a result of a perforated appendix was seen in two patients. Normal laparoscopy was performed in five patients and four patients who presented with a perforated duodenal ulcer had the diagnosis confirmed at laparoscopy, in three cases the perforation was oversewn laparoscopically. Two laparoscopies were performed on trauma patients; one stabbing and one blunt trauma to the right hypochondrium. It has been demonstrated that diagnostic laparoscopy is a useful adjunct to the general surgeon's armamentarium. It is suggested that the skill of laparoscopy is passed on to junior trainee surgeons who can use this technique to help attain a diagnosis in patients presenting with an acute abdomen.
讨论了腹腔镜检查在一家外科科室收治的急腹症患者治疗中的作用。在18个月期间共进行了67例腹腔镜检查，其改变了19.4%病例的诊断和13.4%病例的治疗。腹腔镜检查时，37例患者诊断为阑尾炎（81%尝试行腹腔镜阑尾切除术）；15例患者为盆腔炎；2例患者为扭转的输卵管系膜囊肿；2例患者因阑尾穿孔可见右下腹腹膜游离脓液。5例患者腹腔镜检查正常，4例十二指肠溃疡穿孔患者经腹腔镜检查确诊，3例患者在腹腔镜下缝合了穿孔。对2例创伤患者进行了腹腔镜检查；1例为刺伤，1例为右季肋部钝性伤。已证明诊断性腹腔镜检查是普通外科医生有用的辅助手段。建议将腹腔镜检查技术传授给初级实习外科医生，他们可以使用该技术帮助对急腹症患者作出诊断。
