D'Errico Emanuele, Goffre Beatrice, Mazza Davide
Department of Digestive Surgery, CH Toulon-La Seyne, France.
Chir Ital. 2009 Sep-Dec;61(5-6):601-6.
Management of blunt abdominal trauma has evolved over the last decade and non-operative management (NOM), initially viewed with scepticism, has now become widely used. The aim of this retrospective study was to examine the results of liberal utilisation of NOM of blunt abdominal trauma. For that purpose we examined the charts of 119 patients admitted to our Department of Surgery from January 1998 to July 2006 for blunt abdominal trauma. NOM was opted for in cases of haemodynamic stability. When surgery was mandatory, it consisted in exploratory laparotomy or laparoscopy. Six of the NOM patients (7%) needed surgical exploration during the 24 hours following the trauma. Thus, the success rate for NOM was 93%. Mean length of hospital stay was 12.5 days (range: 2-78); for emergency surgery patients it was 17 days (range: 2-78), and for NOM patients 14.5 days (range: 2-45). In conclusion, NOM may be safely used in cases of blunt abdominal trauma. Haemodynamic instability, suspicion of hollow viscus perforation and multiple transfusions are contraindications to this approach.
在过去十年中，钝性腹部创伤的处理方法不断演变，非手术治疗（NOM）最初受到质疑，如今已被广泛应用。这项回顾性研究的目的是探讨钝性腹部创伤广泛采用非手术治疗的结果。为此，我们查阅了1998年1月至2006年7月间因钝性腹部创伤入住我院外科的119例患者的病历。对于血流动力学稳定的病例选择非手术治疗。若必须进行手术，则采用剖腹探查术或腹腔镜检查。6例非手术治疗患者（7%）在创伤后24小时内需要进行手术探查。因此，非手术治疗的成功率为93%。平均住院时间为12.5天（范围：2 - 78天）；急诊手术患者为17天（范围：2 - 78天），非手术治疗患者为14.5天（范围：2 - 45天）。总之，钝性腹部创伤病例可安全采用非手术治疗。血流动力学不稳定、怀疑中空脏器穿孔和多次输血是这种治疗方法的禁忌证。
