Waclawiczek H W, Schneeberger V, Bekk A, Dinnewitzer A, Sungler P, Boeckl O
I. Chirurgische Abteilung, Landeskrankenanstalten Salzburg.
Zentralbl Chir. 1997;122(12):1108-12.
During the last three years 172 diagnostic laparoscopies (DL) were performed at our department in patients with an acute abdomen of unclear causes. This corresponds to 17% of all patients who underwent operation due to an acute abdomen in the same period. Always the indication for a diagnostic laparoscopy arose then, when the cause or the localization of the acute abdomen could not be found by conventional diagnostic methods. The advantages of DL were either the confirmation (93%) or the exclusion (7%) of the diagnosis "acute abdomen", the exact localization and simultaneously a definitive operative treatment of the cause by minimal invasive interventions (n = 109/65%). In these patients with acute abdomen the main causes were acute inflammations of gallbladder (n = 48) and appendix (n = 29), ulcus perforations (n = 9) and ileus (n = 9). The conversion rate amounted to 2.7%, the postoperative complication rate to 11% and the lethality rate to 1.8% in these patients. A new indication is the so-called "bedside laparoscopy" as means to control the postoperative course of mesenteric embolism (n = 9) and diffuse peritonitis (n = 3) in order to avoid the stress of a second-look operation for these seriously ill patients or to secure the indication for relaparotomy.
在过去三年中，我们科室对病因不明的急腹症患者进行了172例诊断性腹腔镜检查（DL）。这相当于同期因急腹症接受手术的所有患者的17%。当通过传统诊断方法无法找到急腹症的病因或部位时，就会产生诊断性腹腔镜检查的指征。DL的优点在于确诊（93%）或排除（7%）“急腹症”的诊断，精确确定部位，同时通过微创干预对病因进行确定性手术治疗（n = 109/65%）。在这些急腹症患者中，主要病因是胆囊急性炎症（n = 48）、阑尾急性炎症（n = 29）、溃疡穿孔（n = 9）和肠梗阻（n = 9）。这些患者的中转开腹率为2.7%，术后并发症率为11%，死亡率为1.8%。一种新的指征是所谓的“床边腹腔镜检查”，作为控制肠系膜栓塞（n = 9）和弥漫性腹膜炎（n = 3）术后病程的手段，以避免对这些重症患者进行二次探查手术的应激，或确定再次剖腹手术的指征。
