...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Surgical Endoscopy >Accuracy of diagnostic laparoscopy for early diagnosis of abdominal complications after cardiac surgery.
【24h】

Accuracy of diagnostic laparoscopy for early diagnosis of abdominal complications after cardiac surgery.

机译：诊断性腹腔镜检查在心脏手术后腹部并发症早期诊断中的准确性。

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Background: In the early postoperative period after major cardiac surgery using extracorporal circulation, abdominal complications can have serious consequences with a mortality rate of up to 70%. Early diagnosis and the timely institution of therapy are the most important factors to improve the outcome; however, clinical evaluation of the abdomen is difficult in these patients. Diagnostic laparoscopy is a minimally invasive procedure with low procedure-associated morbidity, even in critically ill patients. The aims of our study were to investigate the safety of laparoscopy in critically ill patients suspected to have intraabdominal pathology following cardiac surgery and to evaluate the accuracy of diagnostic laparoscopy compared to laparotomy in this setting. Methods: A total of 17 patients were included (13 male, four female, age 52-80 years) in the early (3-30 days) postoperative period after cardiac surgery using extracorporal circulation (10 ACVB, four valve replacement, one aorto-coronary-venous-bypass (ACVB)+ valve replacement, two cardiac transplantation). Clinical and laboratory findings included distended abdomen (17 of 17), elevated white blood cells (12 of 17), elevated C-reactive protein (CRP) (13 of 17), and elevated lactate levels (11 of 17). The decision to perform laparotomy was taken in all patients on the basis of their clinical condition. Diagnostic laparoscopy was always performed immediately before laparotomy. The laparoscopic findings were then compared to the laparotomy findings. Results: In one patient, laparoscopy showed no abnormal findings, this was confirmed on laparotomy. Five patients were found to have massive distension of the large bowel without ischemia on both laparoscopy and laparotomy. Colonic ischemia of the right hemicolon was found laparoscopically in six patients, which was confirmed in all cases by open resection and histological workup. Three patients suffered from acute cholecystitis, which was correctly diagnosed by laparoscopy in all cases. In one patient, laparoscopy revealed fibrinous peritonitis without other findings. Open exploration failed to identify the cause of the peritonitis in this patient. Laparoscopy showed no pathological findings in one patient, but laparotomy then revealed necrotizing pancreatitis confined to the lesser sac. There was one laparoscopy-associated intraoperative complication (6%) in this series. Conclusions: Diagnostic laparoscopy is a minimally invasive procedure that can be performed at low intraoperative risk in critically ill patients and has a high sensitivity (94%) for the correct diagnosis of intraabdominal complications after major cardiac surgery. These results suggest that bedside laparoscopy should be considered for all patients with equivocal abdominal symptoms in this setting.
机译：背景：在采用体外循环进行大心脏手术的术后早期，腹部并发症可能会导致严重后果，死亡率高达70％。早期诊断和及时治疗是改善预后的最重要因素。然而，这些患者的腹部临床评估很困难。诊断性腹腔镜检查是一种微创手术，即使在危重患者中，其与手术相关的发病率也较低。我们研究的目的是研究在心脏手术后怀疑患有腹腔病理的危重患者中进行腹腔镜检查的安全性，并评估与腹腔镜手术相比在这种情况下诊断性腹腔镜检查的准确性。方法：共计17例患者在术后早期（3-30天）采用体外循环（10 ACVB，四瓣置换，一主动脉切开术）（男13例，女4例，年龄52-80岁）。冠状静脉旁路（ACVB）+瓣膜置换术，两次心脏移植）。临床和实验室检查结果包括腹部胀大（17中的17），白细胞升高（12中的12），C反应蛋白（CRP）升高（13中的17）和乳酸水平升高（17中的11）。所有患者均根据其临床情况决定进行剖腹手术。诊断性腹腔镜检查总是在剖腹手术前立即进行。然后将腹腔镜检查结果与开腹手术结果进行比较。结果：在一名患者中，腹腔镜检查未发现异常发现，这一点在剖腹手术中得到了证实。在腹腔镜检查和剖腹手术中，发现五名患者大肠大面积扩张，无缺血。腹腔镜检查发现6例右半结肠结肠缺血，所有病例均经开放切除和组织学检查证实。三例患者均患有急性胆囊炎，经腹腔镜检查可正确诊断所有病例。一名患者的腹腔镜检查显示纤维化性腹膜炎，无其他发现。公开探查未能确定该患者腹膜炎的原因。腹腔镜检查未发现一名患者有任何病理学发现，但剖腹手术后发现坏死性胰腺炎局限于小囊内。该系列中有1例腹腔镜相关的术中并发症（6％）。结论：诊断性腹腔镜检查是一种微创手术，可以在危重患者中以较低的术中风险进行手术，并且对重大心脏手术后的腹腔内并发症的正确诊断具有较高的敏感性（94％）。这些结果表明，在这种情况下，应为所有腹部模棱两可的患者考虑床旁腹腔镜检查。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号