目的 探讨腹腔镜在原因不明腹痛诊断和治疗中应用的可行性。方法 总结分析44例原因不明的腹痛经腹腔镜诊治的临床资料。结果 全组44例患者均获病理学诊断，其中诊断为腹腔结核23例，肠粘连17例，小肠平滑肌肉瘤、非霍奇金病、晚期胃癌、腹茧症各1例。24例（54.6%）明确诊断后予以内科治疗，17例（38.6%）同时采用腹腔镜治疗，2例（4.5%）中转开腹，1例（2.3%）明确诊断后延期接受开腹手术治疗。所有病例经腹腔镜检查和治疗后，除1例晚期胃癌患者因延期开腹行姑息性手术后恢复差而死亡，其余无并发症发生。结论 腹腔镜是诊断和治疗原因不明腹痛的有效手段，部分病例为后续治疗提供了可靠的依据，部分病例可同时在腹腔镜下完成治疗手术。
Objective To summarize the clinical therapeutic efficacy of emergent laparoscopic cholecystectomy （LC） and emergent open cholecystectomy （OC）. Methods One hundred and thirty-three patients with acute cholecystitis from March 2011 to June 2012 in this hospital were randomly divided into emergent LC （ELC） group and emergent OC （EOC） group. The examination and treatment before and after operation were the same. The clinical data before and during operation， postoperative complications， and recovery conditions were observed and compared. Results There was no obvious difference of the clinical data before operation between the ELC group and EOC group （P＞0.05）. Also， there were no significant differences of the operation time， biliary duct injury rate， postoperative bleeding rate， and reoperation rate in two groups （P＞0.05）. The time of postoperative anal exsufflation， time of out-of-bed activity， and postoperative hospital stay in the ELC group were significantly shorter than those in the EOC group （P＜0.05）， the poor incision healing rate in the ELC group was significantly lower than that in the EOC group （P＜0.05）， and the intraoperative blood loss in the ELC group was significantly less than that in the EOC group （P＜0.05）. Conclusions ELC as compared with EOC， are less intraoperative blood loss， less postoperative complications， more rapid recovery， and do not increase operation time. In a hospital with skilled LC technique， ELC is safe and feasible， has obvious advantages of minimal invasion.
Objective To explore the value of CT guided percutaneous puncture, aspiration and drainage on diagnosis and treatment of local complications of severe acute pancreatitis (SAP). Methods Forty-three cases of SAP combined with pancreatic necrosis, peripancreatic hydrops, pseudocyst and abscess were analyzed, all of them underwent CT guided percutaneous puncture, aspiration and drainage. Results The punctures were performed on 43 SAP patients for sixty-four times, the success rate was 100%, and in 24 cases of them puncture were performed for diagnosis, the positive rate of fluid absorption by puncture was 100%. Forty-one of 43 cases (95%) received puncture and tube drainage, open operation was performed in one patient, one patient was automatically discharged. The remission rate of abdominal distension was 93% (40/43) and 16 of 43 cases (37%) were turned to open operation. The effective rate of drainage was 61% (25/41). Conclusion The puncture, aspiration and drainage guided by CT is an effective method in diagnosis and treatment of local complications in part of SAP cases.