腹腔镜对慢性不明原因腹痛的诊断与治疗价值

摘要

目的 探讨腹腔镜诊治慢性不明原因腹痛的价值. 方法 回顾性分析我院2014年1月~2016年2月56例慢性不明原因腹痛行腹腔镜手术的临床资料,先进行腹腔镜探查,发现异常进行对应处理. 结果 明确病因48例(85.7%),包括腹腔粘连25例,慢性阑尾炎8例,小肠憩室2例,肠结核2例,淋巴瘤2例,子宫内膜异位5例,输卵管粘连2例,胃癌术后腹膜转移1例,阑尾黏液腺癌1例.手术治疗43例,其中3例中转开腹.56例均无术后并发症.随访率92.9%(52/56),失访4例.52例术后随访3个月~3年(中位数19.4月).死亡1例(腹膜转移癌).腹痛完全缓解(未再出现术前腹痛症状)35例(62.5%),疼痛减轻(疼痛程度减弱或间隔延长)12例(21.4%),总有效率83.9%(47/56). 结论 腹腔镜在慢性不明原因腹痛中具有较高的诊断和治疗价值.%Objective To investigate the value of laparoscopy in the diagnosis and treatment of unexplained chronic abdominal pain.Methods From January 2014 to February 2016, clinical data of 56 unexplained chronic abdominal pain undergoing laparoscopic surgery were analyzed retrospectively.Laparoscopic exploration was performed firstly and then the corresponding abnormalities were diagnosed and dealt with accordingly.Results The disease causes were explicit in 48 cases (85.7%), including 25 cases of abdominal adhesions, 8 cases of chronic appendicitis, 2 cases of small intestinal diverticulum, 2 cases of intestinal tuberculosis, 2 cases of lymphoma, 5 cases of endometriosis, 2 cases of tubal adhesions, 1 case of peritoneal metastasis of gastric cancer after surgery, and 1 case of appendiceal mucinous adenocarcinoma.Surgical treatment was performed in 43 cases, 3 of whom were converted to laparotomy.There were no postoperative complications in the 56 cases.The follow-up rate was 92.9% (52/56), and lost of follow-up was in 4 cases.The follow-up duration was from 3 months to 3 years (median, 19.4 months).There was 1 death case (peritoneal carcinomatosis).There were 35 cases (62.5%) of complete relief of abdominal pain (no recurrence of preoperative abdominal pain symptoms) and 12 cases (21.4%) of pain relief (preoperative pain decreased or interval extended).The total effective rate was 83.9% (47/56).Conclusion Laparoscopy is of high value in the diagnosis and treatment of unexplained chronic abdominal pain.