Schnüriger Beat, Lam Lydia, Inaba Kenji, Kobayashi Leslie, Barbarino Raffaella, Demetriades Demetrios
Division of Acute Care Surgery, University of Southern California, LAC1USC Medical Center, Los Angeles, California, USA.
Am Surg. 2012 Nov;78(11):1219-23.
One of the trauma surgeons' daily challenges is the balancing act between negative laparotomy and missed abdominal injury. We opted to characterize the indications that prompted a negative trauma exploratory laparotomy and the rate of missed abdominal injuries in an effort to optimize patient selection for laparotomy. At the Los Angeles County + University of Southern California Medical Center, negative laparotomies and missed injuries are consecutively captured and reviewed at the weekly mortality + morbidity (MM) conferences. All written reports of the MM meetings from January 2003 to December 2008 were reviewed to identify all patients who underwent a negative laparotomy or a laparotomy as a result of an initially missed abdominal injury. Over the 6-year study period, a total of 1871 laparotomies were performed, of which 73 (3.9%) were negative. The rate of missed injuries requiring subsequent laparotomy was 1.3 per cent (25 of 1871). The negative laparotomy rate and the rate of missed injuries did not vary significantly during the study period (2.8 to 4.7%, P = 0.875, and 0.7 to 2.9%, P = 0.689). Penetrating mechanisms accounted for the majority of negative laparotomies (58.9%). The primary indication for negative laparotomy was peritonitis (54.8%) followed by hypotension (28.8%) and suspicious computed tomographic scan findings (27.4%). The complication rate after negative laparotomy was 14.5 per cent, and of these, 10.1 per cent were directly related to the procedure. A low but steady rate of negative laparotomies and missed abdominal injuries after trauma remains. Negative laparotomies and missed abdominal injuries when they occur are still associated with significant complication rates and a prolonged length of stay.
创伤外科医生日常面临的挑战之一是在阴性剖腹探查术和漏诊腹部损伤之间进行权衡。我们选择对促使进行阴性创伤性剖腹探查术的指征以及腹部损伤漏诊率进行特征描述，以优化剖腹探查术的患者选择。在洛杉矶县+南加州大学医学中心，阴性剖腹探查术和漏诊损伤在每周的死亡率和发病率（MM）会议上被连续记录并审查。对2003年1月至2008年12月MM会议的所有书面报告进行审查，以确定所有接受阴性剖腹探查术或因最初漏诊腹部损伤而进行剖腹探查术的患者。在6年的研究期间，共进行了1871例剖腹探查术，其中73例（3.9%）为阴性。需要后续剖腹探查术的损伤漏诊率为1.3%（1871例中的25例）。在研究期间，阴性剖腹探查术率和损伤漏诊率没有显著变化（2.8%至4.7%，P = 0.875；0.7%至2.9%，P = 0.689）。穿透性机制占阴性剖腹探查术的大多数（58.9%）。阴性剖腹探查术的主要指征是腹膜炎（54.8%），其次是低血压（28.8%）和可疑的计算机断层扫描结果（27.4%）。阴性剖腹探查术后的并发症发生率为14.5%，其中10.1%与手术直接相关。创伤后阴性剖腹探查术和腹部损伤漏诊率仍然较低但较为稳定。阴性剖腹探查术和腹部损伤漏诊一旦发生，仍与显著的并发症发生率和延长的住院时间相关。
