Emergency laparoscopy - A community hospital experience
Emergency laparoscopy - A community hospital experience
复制标题
DOI：
10.1007/s004640000022
复制
发表时间：
2000-05-01
期刊：
影响因子：
--
通讯作者：
Bedin, N
中科院分区：
文献类型：
--
作者：
Agresta, F;Michelet, I;Bedin, N
背景：到目前为止，腹腔镜手术已经得到了外科医生的广泛接受，一般来说，公众。因此，我们开始评估这项技术是否是一种可行的方法，治疗腹部急症，创伤或没有。为了评估在社区医院设置的常规使用紧急腹腔镜检查，我们进行了一项回顾性分析的非随机经验（存在或不存在的外科医生与腹腔镜经验）：1993年1月至1998年10月，575紧急腹部外科手术在我们的部门。365例（63.4%）为诊断性和手术性腹腔镜手术（急性小肠梗阻：23例;疝疾病：1例;胃十二指肠溃疡疾病：15例;胆道系统疾病：89例;盆腔疾病：237例）。这些病例占同期在我们机构完成的所有腹腔镜手术的近56%。腹腔镜检查不进行的患者的历史，以前的腹部方法恶性疾病，一个历史上的两个以上的重大腹部手术，或巨大的肠道膨胀，也不是用于患者的一般条件禁忌这种approach.Results：转换率为6.8%。发病率和死亡率分别为4.1%和0.8%。在95.3%的病例中提供了明确的诊断，其中88.2%通过腹腔镜治疗的可能性。结论：我们认为腹腔镜方法在腹部急诊患者中是可行的，安全的，在有经验的手中。它提供诊断准确性以及治疗能力。保留患者的剖腹手术减少了术后疼痛，改善了GI功能的恢复，减少了住院治疗，降低了医疗费用，并改善了美容效果。这种方法的前提下，发挥重要作用，在紧急腹部情况下，肯定会变得越来越重要，在今天的卫生保健环境。
Background: By now, laparoscopic surgery has achieved widespread acceptance among surgeons and, generally speaking, by the public. Therefore, we set out to evaluate whether this technique is a feasible method of treating patients with abdominal emergencies, traumatic or not. To assess the routine use of emergency laparoscopy in a community hospital setting, we undertook a retrospective analysis of an unrandomized experience (presence or absence of a surgeon with laparoscopic experience).Methods: Between January 1993 and October 1998, 575 emergency abdominal surgical procedures were done in our department. In all, 365 (63.4%) were diagnostic and operative laparoscopy procedures (acute small bowel obstruction: 23 cases; hernia disease: one case; gastroduodenal ulcer disease: 15 cases; biliary system disease: 89 cases; pelvic disease: 237 cases). These cases represent almost 56% of all laparoscopic procedures done during the same period at our institution. Laparoscopy was not performed in patients with a history of a previous abdominal approach to malignant disease, a history of more than two major abdominal surgeries, or massive bowel distension; nor was it used in patients whose general conditions contraindicate this approach.Results: The conversion rate was 6.8%. The morbidity and mortality rates were, respectively, 4.1% and 0.8%. A definitive diagnosis was provided in 95.3% of cases, with the possibility to treat 88.2% of them by laparoscopy.Conclusions: We consider the laparoscopic approach in patients with abdominal emergencies to be feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities. Sparing patients laparotomy reduces postoperative pain, improves recovery of GI function, reduces hospitalization, cuts health care costs, and improves cosmetic results. This approach premises to play a significant role in emergency abdominal situations and will certainly become increasingly important in today's health care environment.