Robin A P, Andrews J R, Lange D A, Roberts R R, Moskal M, Barrett J A
Department of Surgery, Cook County Hospital, Chicago, IL.
J Trauma. 1989 Dec;29(12):1684-9. doi: 10.1097/00005373-198912000-00018.
A policy of selective management of anterior abdominal stab wounds was evaluated in 333 consecutive patients. Laparotomy was performed based upon initial clinical assessment in 165 patients. There were six deaths (3.6%), major complications in 23 patients (14%), and 28 negative laparotomies (17%). Eighteen patients developed indications for laparotomy after 10.7 +/- 2.2 hours of observation. There were no deaths, major complications in two patients (11%), and four negative laparotomies (22%). One hundred fifty patients were observed and discharged after 1.8 +/- 0.1 days. Sensitivity, specificity, and positive and negative predictive values for initial clinical evaluation were 91%, 85%, 92%, and 83%, respectively. Length of hospitalization in the initially operated and in the delayed group was 9.5 +/- 0.6 and 10.6 +/- 2.6 days (NS), respectively. Most serious intra-abdominal injuries will declare themselves on initial clinical assessment. The remainder are less severe injuries and these patients can be safely observed without undue sequelae due to delay. The use of clinical assessment alone to prompt laparotomy is also cost effective based on analysis of hospital days for initial illness. No procedures are necessary to define penetration.
对333例连续性前腹部刺伤患者实施了选择性处理策略。165例患者根据初始临床评估进行了剖腹手术。有6例死亡（3.6%），23例发生严重并发症（14%），28例剖腹手术阴性（17%）。18例患者在观察10.7±2.2小时后出现剖腹手术指征。无死亡病例，2例发生严重并发症（11%），4例剖腹手术阴性（22%）。150例患者在观察1.8±0.1天后出院。初始临床评估的敏感性、特异性、阳性预测值和阴性预测值分别为91%、85%、92%和83%。初始手术组和延迟手术组的住院时间分别为9.5±0.6天和10.6±2.6天（无显著性差异）。大多数严重的腹部损伤在初始临床评估时即可显现。其余为较轻损伤，这些患者可安全观察，不会因延迟而出现不当后遗症。根据对初始疾病住院天数的分析，仅使用临床评估来促使进行剖腹手术也是具有成本效益的。无需进行任何检查来确定穿透情况。
