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Viszeralchirurgie 2003; 38(2): 137-145
DOI: 10.1055/s-2003-38564
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Der Stellenwert der Laparoskopie beim akuten Abdomen und Abdominaltrauma

The Importance of Laparoscopy in Acute Abdomen and Blunt Abdominal TraumaL.  Meyer1 , A.  Koch1 , T.  Überrück1 , I.  Gastinger1
  • 1Chirurgische Klinik, Carl-Thiem-Klinikum, Cottbus
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Publication History

Publication Date:
11 April 2003 (online)

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Zusammenfassung

Ziel der Untersuchung war es, den Stellenwert der Laparoskopie im Versorgungsablauf des Bauchverletzten und beim akuten Abdomen zu bestimmen. Für die Beurteilung des Stellenwertes der Laparoskopie beim Abdominaltrauma wurde das Krankengut der Chirurgischen Klinik des Carl-Thiem-Klinikums Cottbus aus den Jahren 1998 bis 2002 retrospektiv analysiert. In diesem Zeitraum wurden 104 Patienten wegen eines Bauchtraumas operativ versorgt, davon 33 (31,7 %) primär laparoskopiert. In 18 Fällen wurde der abdominelle Eingriff ohne Konversion laparoskopisch beendet, bei 10 Patienten dabei intraabdominelle Verletzungen laparoskopisch versorgt. Die Rate der so genannten „negativen” Laparotomien lag bei 7,7 %. Beim akuten Abdomen besteht die wichtigste Indikation zur diagnostischen Laparoskopie in der Abklärung unklarer rechtsseitiger Unterbauchbeschwerden. Aber auch in Einzelindikationen (mesenteriale Durchblutungsstörungen, Perforationen, Meckelsches Divertikel, gynäkologische Erkrankungen, Peritonitis unklarer Genese, Dünndarmileus) stellt die diagnostische Laparoskopie ein wichtiges diagnostisches Instrument mit therapeutischer Option dar. Anhand der Daten einer Multizenterstudie mit 1703 diagnostischen Laparoskopien bei Verdacht auf Appendizitis wird der Stellenwert der diagnostischen Laparoskopie im Rahmen der Appendizitisbehandlung dargestellt. Gute Einzelindikationen werden in Falldarstellungen und Literaturanalysen erörtert. Damit sollte die Laparoskopie unserer Meinung nach einen festen Platz im diagnostischen und gegebenenfalls therapeutischen Prozedere beim Bauchtrauma und akuten Abdomen einnehmen.

Abstract

The importance of laparoscopy in the management of acute abdomen and blunt abdominal trauma should be evaluated. Therefore we retrospectively analysed all patients with blunt abdominal trauma treated in the Department of Surgery at the Carl-Thiem-Hospital Cottbus between 1998 and 2002. Within this period a total number of 104 patients with blunt abdominal trauma underwent operative treatment, 33 (31,7 %) of them had primary laparoscopy. Of the 18 cases where laparoscopic operation could be completed without conversion to exploratory laparotomy, 10 patients had intra-abdominal injuries and underwent sufficient laparoscopic treatment. The percentage of so called „negative” exploratory laparotomies within this study was 7,7 %. Diagnostic laparoscopy in patients with unclear right hand side lower abdominal pain is the most important indication in acute abdomen. In special cases (mesenteric ischemia, perforations, Meckel's diverticulum, gynecopathies, peritonitis of unknown origin, small bowel obstruction) laparoscopy is an usefull diagnostic tool with a therapeutic option. The value of diagnostic laparoscopy is demonstrated by means of the data of a multicenter trial with 1703 diagnostic laparoscopies under suspicion of acute appendicitis. Special indications are discussed on the basis of case studies and the literature. Our analysis suggests that laparoscopy should become firmly established in the diagnostic management and, if indicated, in the treatment of acute abdomen and blunt abdominal trauma as well.

Schlüsselwörter

Akutes Abdomen - Bauchtrauma - diagnostische Laparoskopie - laparoskopische Therapie

Key words

Acute abdomen - blunt abdominal trauma - diagnostic laparoscopy - laparoscopic treatment

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Dr. Lutz Meyer

Chirurgische Klinik, Carl-Thiem-Klinikum, Chirurgische Endoskopie

Thiemstraße 111

03048 Cottbus

Phone: 0355/462327

Fax: 0355/462337

Email: L.Meyer@ctk.de