华西医学

华西医学

腹腔镜在急腹症诊疗应用的进展——欧洲内镜外科协会共识解读

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腹腔镜已成为诊治急腹症常用的手段,其在选择性的病例中具有良好的诊断价值和治疗效果。其应由具备丰富的腹腔镜手术和急诊腹部外科经验的外科医生来开展。血流动力学不稳定、严重腹胀、粪性腹膜炎和肿瘤穿孔是应用腹腔镜的相对禁忌证。近年来,越来越多的急性腹部疾病可由腹腔镜成功诊治。随机对照试验已证明腹腔镜治疗在急性阑尾炎、急性胆囊炎、消化性溃疡穿孔、急性妇科疾病的应用与开腹手术是同样安全和有效的,并且具有并发症更少、术后恢复更快的优势。其他疾病如钝性和穿通性腹部外伤、小肠梗阻和憩室炎伴穿孔应用腹腔镜诊疗仍存争议,尚需更多随机对照试验来比较腹腔镜与开腹手术在其应用的可行性。

Laparoscopy has become a commonly used approach to diagnosis and treatment of acute abdomen, and it has good diagnostic value and therapeutic effect in selective cases. It should be practiced by experienced surgeons in laparoscopic surgery and emergency abdominal surgery. Hemodynamic instability, severe abdominal distension, fecal peritonitis, and tumor perforation are contraindications to laparoscopy. In recent years, more and more acute abdominal diseases can be successfully treated by laparoscopy. Randomized controlled trials have proved the laparoscopic treatment in acute appendicitis, acute cholecystitis, peptic ulcer perforation, acute gynecological diseases was comparable to open surgery, and had advantages of fewer complications and faster postoperative recovery. The utilization of laparoscopy in other diseases such as blunt and penetrating abdominal trauma, small intestinal obstruction, and diverticulitis remains controversial, and needs more randomized controlled trials to investigate the feasibility of laparoscopic surgery.

关键词: 腹腔镜; 急腹症; 指南; 规范; 共识

Key words: Laparoscopy; Acute abdomen; Guideline; Standard; Consensus

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