Ponifasio P, Poki H O, Watters D A
Department of Clinical Sciences, University of Papua New Guinea, Port Moresby.
P N G Med J. 2001 Mar-Jun;44(1-2):36-42.
Trauma is the commonest cause of surgical admission in Papua New Guinea, accounting for around 30% of cases in Port Moresby and over 40% in the highlands. The abdomen is traumatized in about 10-15% of trauma cases. In malarial endemic areas the enlarged spleen is particularly prone to rupture although earlier studies showed that this injury can often be managed conservatively.
To determine the pattern and outcome of abdominal injury in the two largest cities, Port Moresby and Lae, in the 1990s.
A retrospective study of 213 adult admissions for abdominal trauma in Port Moresby and a prospective study of 98 adult abdominal trauma patients in Lae. In both centres malaria is endemic. Statistical analysis where appropriate was made using the chi2 test.
Abdominal trauma was more likely to affect men outside the home and women in the home. Assault was responsible for 72% of cases of abdominal trauma. Women were assaulted by their husbands in two-thirds of cases. The spleen was the most likely organ to be injured, particularly in blunt trauma. Road traffic accidents caused only 10% of admissions with abdominal trauma. Most patients were admitted with a single injury. Splenic injury was managed nonoperatively in over 60% of cases. The negative laparotomy rate was 7% in Port Moresby and 20% in Lae, but negative laparotomy did not cause any deaths or extra morbidity. 17 patients (5.5%) died, the highest case fatality rate being 29% in a group of 31 patients with an injury severity score of 25 or greater.
The pattern of abdominal trauma reflects the culture of Papua New Guinea and the different spectrum of risks to men and women. Once patients reach hospital they tend to do reasonably well although there is room for improvement, particularly with early assessment of the extent of the injury. The enlarged spleen is prone to injury and in those cases requiring laparotomy it is difficult to conserve. Many cases of ruptured spleen can be treated nonoperatively.
创伤是巴布亚新几内亚外科住院最常见的原因，在莫尔斯比港约占病例的30%，在高地超过40%。约10%-15%的创伤病例腹部受到创伤。在疟疾流行地区，肿大的脾脏特别容易破裂，尽管早期研究表明这种损伤通常可以保守治疗。
确定20世纪90年代两个最大城市莫尔斯比港和莱城腹部损伤的模式和结果。
对莫尔斯比港213例成年腹部创伤住院病例进行回顾性研究，对莱城98例成年腹部创伤患者进行前瞻性研究。两个中心均为疟疾流行区。适当情况下使用卡方检验进行统计分析。
腹部创伤在户外更易影响男性，在家中更易影响女性。袭击导致72%的腹部创伤病例。三分之二的病例中女性是被丈夫袭击。脾脏是最易受伤的器官，尤其是在钝性创伤中。道路交通事故仅导致10%的腹部创伤住院病例。大多数患者因单一损伤入院。超过60%的脾损伤病例采用非手术治疗。莫尔斯比港的阴性剖腹率为7%，莱城为20%，但阴性剖腹未导致任何死亡或额外的发病率。17例患者（5.5%）死亡，在一组损伤严重程度评分为25分或更高的31例患者中，最高病死率为29%。
腹部创伤模式反映了巴布亚新几内亚的文化以及男性和女性面临的不同风险范围。一旦患者到达医院，他们的情况往往相当不错，尽管仍有改进空间，特别是在早期评估损伤程度方面。肿大的脾脏容易受伤，在那些需要剖腹手术的病例中很难保留。许多脾破裂病例可以非手术治疗。
