词条 | Laparotomy |
释义 |
| name = Laparotomy | synonym = Celiotomy | image = | caption = | alt = | pronounce = | specialty = General surgery | synonyms = | ICD10 = | ICD9 = | ICD9unlinked = | CPT = | MeshID = | LOINC = | other_codes = | MedlinePlus = | eMedicine = }} A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy. The first successful laparotomy was performed without anesthesia by Ephraim McDowell in 1809 in Danville, Kentucky. TerminologyThe term arises from the Greek word λᾰπάρᾱ ("lapara"), meaning "the soft part of the body between the ribs and hip, flank,"[1] and the suffix "-tomy" arising from the Greek word "τομή" meaning "a (surgical) cut." In diagnostic laparotomy (most often referred to as an exploratory laparotomy and abbreviated ex-lap), the nature of the disease is unknown, and laparotomy is deemed the best way to identify the cause. In therapeutic laparotomy, a cause has been identified (e.g. colon cancer) and the operation is required for its therapy. Usually, only exploratory laparotomy is considered a stand-alone surgical operation. When a specific operation is already planned, laparotomy is considered merely the first step of the procedure. Spaces accessedDepending on incision placement, laparotomy may give access to any abdominal organ or space, and is the first step in any major diagnostic or therapeutic surgical procedure of these organs, which include:
Types of incisions{{Main|Surgical Incisions}}MidlineThe most common incision for laparotomy a vertical incision in the middle of the abdomen which follows the linea alba.
Midline incisions are particularly favoured in diagnostic laparotomy, as they allow wide access to most of the abdominal cavity. Midline incision
OtherOther common laparotomy incisions include:
Complications following laparotomyGlobally, there are few studies comparing perioperative mortality following laparotomy across different health systems. One major prospective study of 10,745 adult patients undergoing emergency laparotomy from 357 centres in 58 high-, middle-, and low-income countries found that mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors.[10] In this study the overall global mortality rate was 1.6 percent at 24 hours (high 1.1 percent, middle 1.9 percent, low 3.4 percent; P < 0.001), increasing to 5.4 percent by 30 days (high 4.5 percent, middle 6.0 percent, low 8.6 percent; P < 0.001). Of the 578 patients who died, 404 (69.9 percent) did so between 24 h and 30 days following surgery (high 74.2 percent, middle 68.8 percent, low 60.5 percent). Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days. Taking a similar approach, a unique global study of 1,409 children undergoing emergency laparotomy from 253 centres in 43 countries showed that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed in these settings. Internationally, the most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries.[11] Related proceduresA related procedure is laparoscopy, where cameras and other instruments are inserted into the peritoneal cavity via small holes in the abdomen. For example, an appendectomy can be done either by a laparotomy or by a laparoscopic approach. See also
References1. ^{{cite web |url= http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.04.0057:alphabetic+letter=*l:entry+group=11:entry=lapa/ra_ |title=Henry George Liddell, Robert Scott, A Greek-English Lexicon, λ , λα_ο-σεβής , λα^πάρα_|website=www.perseus.tufts.edu|access-date=2018-08-02}} 2. ^{{WhoNamedIt|synd|1010}} 3. ^{{cite journal | vauthors = Williams GR | title = Presidential Address: a history of appendicitis. With anecdotes illustrating its importance | journal = Annals of Surgery | volume = 197 | issue = 5 | pages = 495–506 | date = May 1983 | pmid = 6342553 | pmc = 1353017 | doi = 10.1097/00000658-198305000-00001| url = https://www.oumedicine.com/docs/ad-surgery-workfiles/williams_history-of-appendicitis-with-anecdotes-illustrating-its-importance.pdf }} 4. ^{{WhoNamedIt|synd|2500}} 5. ^{{cite journal | vauthors = Pfannenstiel HJ | title = Ueber die Vortheile des suprasymphysären Fascienquerschnitts für die gynäkologischen Koeliotomien | trans-title = On the Advantages of the Suprasymphyseal Fascia Cross Section for Gynecological Coeliotomies | language = German | journal = (Volkmann's) Sammlung Klinischer Vorträge | location = Leipzig | date = 1900 | volume = 268 | issue = Gynäk. Nr. 97 | pages = 1735–1756 }} 6. ^{{cite journal | vauthors = Giacalone PL, Daures JP, Vignal J, Herisson C, Hedon B, Laffargue F | title = Pfannenstiel versus Maylard incision for cesarean delivery: A randomized controlled trial | journal = Obstetrics and Gynecology | volume = 99 | issue = 5 Pt 1 | pages = 745–50 | date = May 2002 | pmid = 11978282 | doi = 10.1016/S0029-7844(02)01957-9 }} 7. ^{{cite journal | vauthors = Slater SD | title = Alfred Ernest Maylard, 1855-1947: Glasgow surgeon extraordinaire | journal = Scottish Medical Journal | volume = 39 | issue = 3 | pages = 86–90 | date = June 1994 | pmid = 8720774 | doi = 10.1177/003693309403900312 }} 8. ^{{cite journal | vauthors = Bajpai M, Kumar A, Gupta AK, Pawar DK | title = Lumbotomy approach for upper urological tract surgery in children--an analysis of 68 consecutive lumbotomies | journal = European Journal of Pediatric Surgery | volume = 14 | issue = 3 | pages = 163–7 | date = June 2004 | pmid = 15211405 | doi = 10.1055/s-2004-820903 }} 9. ^{{cite book | vauthors = Tizzano AP, Muffly TM | chapter = Historical milestones in female pelvic surgery, gynecology, and female urology. | title = Urogynecology and Reconstructive Pelvic Surgery | edition = 3rd | date = 2007 | pages = 3–15 | chapter-url = https://urogyn.coloradowomenshealth.com/media/Historical-Milestones-in-Female-Pelvic-Surgery-Gynecology-and-Female-Urology.pdf }} 10. ^{{cite journal | title = Mortality of emergency abdominal surgery in high-, middle- and low-income countries | journal = The British Journal of Surgery | volume = 103 | issue = 8 | pages = 971–988 | date = July 2016 | pmid = 27145169 | doi = 10.1002/bjs.10151 | hdl = 20.500.11820/7c4589f5-7845-4405-a384-dfb5653e2163 | author1 = GlobalSurg Collaborative }} 11. ^{{cite journal | title = Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries | journal = BMJ Global Health | volume = 1 | issue = 4 | pages = e000091 | year = 2016 | pmid = 28588977 | pmc = 5321375 | doi = 10.1136/bmjgh-2016-000091 | author1 = GlobalSurg Collaborative }} External links
1 : Digestive system surgery |
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