腹腔鏡探查術與開腹探查術在診斷不明急腹癥中的臨床對比應用研究

【摘 要】 目的 探討腹腔鏡探查術與開腹探查術在診斷不明急腹癥中的臨床應用價值及各自的優缺點。方法 將60例具有手術指征的急腹癥患者，隨機分為腹腔鏡手術組及開腹手術組，各自30例患者，比較2組平均手術時間、術中出血量、腸道功能恢復時間、住院時間。結果 30例成功施行了腹腔鏡手術的急腹癥患者平均手術時間較開腹手術時間短，術中出血量明顯少于開腹手術，腸道功能恢復時間較開腹手術明顯提前，住院時間均短于開腹手術，且腹腔鏡組患者術后均未使用鎮痛藥物。結論 腹腔鏡探查術在治療不明原因的急腹癥較傳統開腹手術具有明顯的優勢，其創傷小，術中及術后并發癥少，術后恢復可，而且具有診斷和治療價值，值得在臨床上推廣。

【關鍵詞】 急腹癥；腹腔鏡探查術；開腹探查術

【中圖分類號】 R605 【文獻標識碼】 A

【Abstract】 Objective To study the laparoscopic surgical exploration and open surgical exploration in the diagnosis of unknown of the clinical application value of acute abdominal pain and their respective advantages and disadvantages.Methods 60 cases of patients with operation indications of acute abdominal pain，were randomly divided into laparoscopic surgery group and the open surgery group，each 30 patients，compare two groups average operation time，intraoperative blood loss，the intestinal function recovery time，hospital stay.Results 30 cases of successfully implemented the laparoscopic surgery in the patients with acute abdomen average operation time is short open operation time，intraoperative blood loss significantly less than laparotomy，the intestinal function recovery time than laparotomy early obviously，length of hospital stay were shorter than laparotomy，and postoperative patients with laparoscopic group were not use of analgesic drugs.Conclusion laparoscopic surgical exploration in the treatment of acute abdominal pain of unknown origin than traditional open operation has obvious advantages，its small trauma，less intraoperative and postoperative complications， postoperative recovery，and diagnostic and therapeutic value，is worth popularizing in clinic.

【Keywords】 acute abdominal pain；laparoscopic surgical exploration；open surgical exploration

外科急腹癥是一種發病快，病情發展迅速，以急性腹痛為特點，診治要求準確、及時、有效，需要立即處理甚至緊急手術，否則可能會出現生命危險，常見的普外科急腹癥有急性闌尾炎、急性胰腺炎、急性膽囊炎、膽道結石、消化道穿孔等[1]；急腹癥患者常有不同程度的腹部壓痛和反跳痛等腹膜刺激體征，但即使是經驗豐富的外科醫生也會在處理急腹癥時感到棘手，很多時候要面對臨床判斷困境和常規輔助檢查不能提供診斷依據的困境。隨著腹腔鏡廣泛的運用于臨床，腹腔鏡探查術在不明原因急腹癥的診斷與治療中顯現出更多的優勢及其價值，達到了微創治療的目的，是目前醫生和患者的首選方法?！?br>