Lamb C M, Garner J P
Department of Vascular Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham, United Kingdom.
Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham, United Kingdom; Department of Colorectal and General Surgery, Rotherham General Hospital, Rotherham, United Kingdom.
Injury. 2014 Apr;45(4):659-66. doi: 10.1016/j.injury.2013.07.008. Epub 2013 Jul 27.
Selective non-operative management (SNOM) of penetrating abdominal wounds has become increasingly common in the past two or three decades and is now accepted as routine management for stab wounds. Gunshot wounds are more frequently managed with mandatory laparotomy but recently SNOM has been successfully applied. This review systematically appraises the evidence behind SNOM for civilian abdominal gunshot wounds.
A Medline search from 1990 to present identified civilian studies examining success rates for SNOM of abdominal gunshot wounds. Case reports, editorials and abstracts were excluded. All other studies meeting the inclusion criteria of reporting the success rate of non-operative management of abdominal gunshot wounds were analysed.
Sixteen prospective and six retrospective studies met the inclusion criteria, including 18,602 patients with abdominal gunshot wounds. 32.2% (n=6072) of patients were initially managed non-operatively and 15.5% (n=943) required a delayed laparotomy. The presence of haemodynamic instability, peritonitis, GI bleeding or any co-existing pathology that prevented frequent serial examination of the abdomen from being performed were indications for immediate laparotomy in all studies. Delayed laparotomy results in similar outcomes to those in patients subjected to immediate laparotomy. Implementation of SNOM reduces the rates of negative and non-therapeutic laparotomies and reduces overall length of stay.
SNOM can be safely applied to some civilian patients with abdominal gunshot wounds and reduces the rates of negative or non-therapeutic laparotomy. Patients who require delayed laparotomy have similar rates of morbidity and mortality and similar length of stay to those patients who undergo immediate laparotomy.
在过去二三十年里，穿透性腹部创伤的选择性非手术治疗（SNOM）已变得越来越普遍，目前已被接受为刺伤的常规治疗方法。枪伤更多地采用强制性剖腹手术进行治疗，但最近SNOM已成功应用。本综述系统地评估了SNOM用于平民腹部枪伤的证据。
对1990年至今的Medline进行检索，以确定关于腹部枪伤SNOM成功率的平民研究。排除病例报告、社论和摘要。对所有符合纳入标准、报告腹部枪伤非手术治疗成功率的其他研究进行分析。
16项前瞻性研究和6项回顾性研究符合纳入标准，包括18,602例腹部枪伤患者。32.2%（n = 6072）的患者最初采用非手术治疗，15.5%（n = 943）的患者需要延迟剖腹手术。所有研究中，血流动力学不稳定、腹膜炎、胃肠道出血或任何妨碍对腹部进行频繁连续检查的并存病理情况均为立即剖腹手术的指征。延迟剖腹手术的结果与立即接受剖腹手术的患者相似。实施SNOM可降低阴性和非治疗性剖腹手术的发生率，并缩短总住院时间。
SNOM可安全应用于一些平民腹部枪伤患者，并降低阴性或非治疗性剖腹手术的发生率。需要延迟剖腹手术的患者与立即接受剖腹手术的患者的发病率、死亡率和住院时间相似。
