Nagel M, Kopp H, Hagmüller E, Saeger H D
Chirurgische Universitätsklinik Mannheim.
Zentralbl Chir. 1992;117(8):453-9.
From 1973 to 1991 a total of 422 patients underwent surgery because of an abdominal trauma. 12 patients had gunshot wounds and 46 patients stab wounds. In a retrospective study the diagnostic and therapeutic procedure and the indication for surgery are analysed. After gunshot wounds of the abdomen we always performed a laparotomy. In 11 od 12 cases we found serious intra-abdominal injuries. Only in one case the laparotomy was "unnecessary", because of a tangential wound without penetrating of the abdominal wall. After stab wounds the diagnostic and therapeutic management was more selective. Indications for mandatory laparotomy after stab wounds were a manifest hemorrhagic shock, evisceration and a still left weapon in the abdomen (n = 22). The first clinical examination was completed by ultrasound or peritoneal lavage. Pathological findings like free intraperitoneal fluid or a positive lavage also were indications for laparotomy (n = 9). The other patients were observed closely, including repeated physical examination. The indication for surgery then based on the development of clinical signs. The time between first examination and laparotomy was never more than 12 hours. 39 patients (84.7%) had injuries of intraabdominal organs. 5 patients (10.8%) had a negative laparotomy. The mortality rate was 3.4%, but there was no death as a result of the selective approach.
1973年至1991年期间，共有422例患者因腹部创伤接受了手术。其中12例为枪伤，46例为刺伤。通过一项回顾性研究，对诊断和治疗过程以及手术指征进行了分析。腹部枪伤后，我们总是进行剖腹手术。在12例中的11例中，我们发现了严重的腹腔内损伤。只有1例剖腹手术是“不必要的”，因为是腹壁切线伤，未穿透腹壁。刺伤后的诊断和治疗管理更具选择性。刺伤后必须进行剖腹手术的指征包括明显的失血性休克、脏器脱出以及腹部仍留有凶器（n = 22）。首次临床检查通过超声或腹腔灌洗完成。腹腔内游离液体或灌洗阳性等病理结果也是剖腹手术的指征（n = 9）。其他患者密切观察，包括重复体格检查。然后根据临床体征的发展来决定手术指征。首次检查至剖腹手术的时间从未超过12小时。39例（84.7%）患者存在腹腔内器官损伤。5例（10.8%）患者剖腹手术结果为阴性。死亡率为3.4%，但选择性治疗方法未导致死亡。
