腹腔镜在诊断和治疗钝性和穿透性腹部损伤中的应用：10 年在 1 级创伤中心的经验。
The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center.
机构信息
Department of Surgery, University of Oklahoma College of Medicine, 920 Stanton L. Young Blvd, WP 2140, Oklahoma City, OK 73104, USA.
出版信息
Am J Surg. 2013 Mar;205(3):317-20; discussion 321. doi: 10.1016/j.amjsurg.2012.10.021. Epub 2013 Jan 31.
BACKGROUND
Diagnostic laparoscopy (DL) has decreased the rate of nontherapeutic laparotomy for patients suffering from penetrating injuries. We evaluated whether DL similarly lowers the rate of nontherapeutic laparotomy for patients with blunt injuries.
METHODS
All patients undergoing DL over a 10-year period (ie, 2001-2010) in a single level 1 trauma center were classified by the mechanism of injury. Demographic and perioperative data were compared using the Student t and Fisher exact tests.
RESULTS
There were 131 patients included, 22 of whom sustained blunt injuries. Patients suffering from blunt injuries were more severely injured (Injury Severity Score 18.0 vs 7.3, P = .0001). The most common indication for DL after blunt injury was a computed tomographic scan concerning for bowel injury (59.1%). The rate of nontherapeutic laparotomy for patients sustaining penetrating vs blunt injury was 1.8% and nil, respectively.
CONCLUSIONS
DL, when coupled with computed tomographic findings, is an effective tool for the initial management of patients with blunt injuries.
背景
诊断性腹腔镜检查（DL）降低了因穿透性损伤而接受非治疗性剖腹手术的患者的比率。我们评估了 DL 是否同样降低了因钝性损伤而接受非治疗性剖腹手术的患者的比率。
方法
在一个单一的 1 级创伤中心，对 10 年内（即 2001-2010 年）进行的所有 DL 患者进行分类，根据损伤机制进行分类。使用学生 t 检验和 Fisher 精确检验比较人口统计学和围手术期数据。
结果
共纳入 131 例患者，其中 22 例为钝性损伤。钝性损伤患者的损伤更严重（损伤严重程度评分 18.0 对 7.3，P =.0001）。钝性损伤后进行 DL 的最常见指征是 CT 扫描提示肠损伤（59.1%）。穿透性损伤与钝性损伤患者的非治疗性剖腹手术率分别为 1.8%和 0。
结论
当与 CT 结果相结合时，DL 是初始治疗钝性损伤患者的有效工具。
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