背景:腹腔镜检查在几乎所有的外科亚专科中被广泛采用。最初在轻微的腹部紧急情况中找到适应症,它已逐渐成为大多数择期普外科手术的标准方法。尽管有许多技术进步和越来越多的接受度,腹腔镜方法在急诊普外科和腹部创伤中仍未得到充分利用。紧急剖腹手术仍然具有很高的发病率和死亡率。近年来,急诊和创伤外科医生对在急性手术环境中采用微创手术方法越来越感兴趣。目前的立场文件,由世界急诊外科学会(WSES)支持,目的对文献进行综述,以就普外科急诊或腹部创伤需要紧急腹部手术的患者采用腹腔镜优先方法的适应症和益处达成共识.
方法:本立场文件是根据WSES方法开发的。一个指导委员会进行了文献审查并起草了立场文件。一个由54名专家组成的国际小组随后对手稿进行了严格的修订,并进行了详细的讨论,就立场声明达成共识。
结果:总共323项研究(系统评价和荟萃分析,随机临床试验,回顾性比较队列研究,病例系列)已从7409项研究的初始池中选出。证据表明,腹腔镜方法在接受普通外科紧急情况或腹部创伤的急诊腹部手术的稳定患者中具有多种益处。选择稳定的患者对于安全采用腹腔镜方法似乎至关重要。在血流动力学稳定的患者中,腹腔镜手术是安全的,作为治疗工具可行且有效,或有助于确定进一步的管理步骤和需求,从而改善结果,不管转换。适当的患者选择,外科医生的经验和严格的微创手术培训,仍然是增加腹腔镜在急诊普外科和腹部创伤中采用的关键因素。
结论:WSES专家小组建议腹腔镜检查作为因普外科紧急情况和腹部创伤而接受紧急腹部手术的稳定患者的首选方法。
Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma.
This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement.
A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma.
The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.