Laparoscopic approach in gastrointestinal emergencies
Laparoscopic approach in gastrointestinal emergencies
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DOI：
10.3748/wjg.v22.i9.2701
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发表时间：
2016-03-07
影响因子：
4.3
通讯作者：
Padillo Ruiz, Javier
中科院分区：
文献类型：
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作者：
Jimenez Rodriguez, Rosa M.;Jose Segura-Sampedro, Juan;Padillo Ruiz, Javier
这篇综述着重于腹腔镜方法处理胃肠道急症及其最近的适应症。腹腔镜手术在择期手术中占有特殊地位，但不适用于紧急情况。在特定的紧急情况下，有一个巨大的范围内的适应症和不同的技术应用，并不是所有的都是同样解决。我们认为，微创手术最具争议的地方是由于技术上的困难，在紧急情况下的适应症。一些疾病，如食管急症、结肠癌引起的梗阻、腹壁疝或术后嵌顿疝，几乎总是通过常规手术解决，即由于腹腔内空间有限或由于肠的脆弱性而采用开放手术。这些技术问题已经在许多疾病中得到解决，例如对于穿孔性消化性溃疡或急性阑尾切除术，腹腔镜方法已经成为众所周知的和全球支持的程序。另一方面，内窥镜手术已经获得了更多的适应症，将手术解决方案降到了第二位;这发生在胆管炎或胰腺脓肿引流中。这种腔内方法避免了这些疾病的腹腔镜发展的需要。然而，新的仪器和新技术可以将腹腔镜方法扩展到更广泛的潜在程序。然而，还有很长的路要走。
This review focuses on the laparoscopic approach to gastrointestinal emergencies and its more recent indications. Laparoscopic surgery has a specific place in elective procedures, but that does not apply in emergency situations. In specific emergencies, there is a huge range of indications and different techniques to apply, and not all of them are equally settle. We consider that the most controversial points in minimally invasive procedures are indications in emergency situations due to technical difficulties. Some pathologies, such as oesophageal emergencies, obstruction due to colon cancer, abdominal hernias or incarcerated postsurgical hernias, are nearly always resolved by conventional surgery, that is, an open approach due to limited intraabdominal cavity space or due to the vulnerability of the bowel. These technical problems have been solved in many diseases, such as for perforated peptic ulcer or acute appendectomy for which a laparoscopic approach has become a well-known and globally supported procedure. On the other hand, endoscopic procedures have acquired further indications, relegating surgical solutions to a second place; this happens in cholangitis or pancreatic abscess drainage. This endoluminal approach avoids the need for laparoscopic development in these diseases. Nevertheless, new instruments and new technologies could extend the laparoscopic approach to a broader array of potentials procedures. There remains, however, a long way to go.