Ertekin C, Yanar H, Taviloglu K, Güloglu R, Alimoglu O
Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Emerg Med J. 2005 Nov;22(11):790-4. doi: 10.1136/emj.2004.020834.
The modern management of penetrating abdominal trauma has decreased the incidence of unnecessary laparotomy by using selective non-operative management protocols. However, the real benefits of physical examination and different diagnostic methods are still unclear.
From January 2000 to April 2003, we prospectively collected data on 117 patients with penetrating stab wounds to the thoracoabdominal, anterior abdominal, and back regions who had non-operative management. Clinical examination was the primary tool to differentiate those patients requiring operation. Findings of physical examination, ultrasound, computed tomography, endoscopy, echocardiography, diagnostic peritoneal lavage, and diagnostic laparoscopy were reviewed. The number of therapeutic, non-therapeutic, and negative laparotomies were recorded.
Non-operative management was successful in 79% of patients. There were 11 early (within 8 hours of admission) and 14 delayed (more than 8 hours after admission) laparotomies performed, depending on the results of various diagnostic procedures. Non-operative management failed in 21% of patients, and the rate of non-therapeutic laparotomy in early and delayed laparatomy groups was 9% and 14% respectively. There was no negative laparatomy.
The use of physical examination alone and/or together with different diagnostic methods allows reduction of non-therapeutic laparotomies and elimination of negative laparatomies.
穿透性腹部创伤的现代管理方法通过采用选择性非手术管理方案降低了不必要剖腹手术的发生率。然而，体格检查和不同诊断方法的实际益处仍不明确。
2000年1月至2003年4月，我们前瞻性收集了117例胸腹部、前腹部和背部遭受穿透性刺伤且接受非手术治疗患者的数据。临床检查是区分那些需要手术治疗患者的主要手段。回顾了体格检查、超声、计算机断层扫描、内镜检查、超声心动图、诊断性腹腔灌洗和诊断性腹腔镜检查的结果。记录了治疗性、非治疗性和阴性剖腹手术的数量。
79%的患者非手术治疗成功。根据各种诊断程序的结果，进行了11例早期（入院8小时内）和14例延迟（入院8小时后）剖腹手术。21%的患者非手术治疗失败，早期和延迟剖腹手术组的非治疗性剖腹手术率分别为9%和14%。没有阴性剖腹手术。
单独使用体格检查和/或与不同诊断方法联合使用可减少非治疗性剖腹手术并消除阴性剖腹手术。
