van Gool Matthijs H, Giannakopoulos Georgios F, Geeraedts Leo M G, de Lange-de Klerk Elly S M, Zuidema Wietse P
Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands,
Langenbecks Arch Surg. 2015 Jan;400(1):83-90. doi: 10.1007/s00423-014-1260-0. Epub 2014 Dec 23.
Laparotomy is a potential life-saving procedure after traumatic abdominal injury. There is limited literature about morbidity and mortality rates after trauma laparotomy. The primary aim of this study is to describe the complications which may occur due to laparotomy for trauma.
Retrospective evaluated single-centre study with data registry up to 1 year after initial laparotomy for trauma was performed in a level 1 trauma centre in The Netherlands. Between January 2000 and January 2011, a total of 2390 severely injured trauma patients (ISS ≥ 16) were transported to the VUMC. Patient demographics; mechanism of injury; injury patterns defined by Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and Revised Trauma Score (RTS); surgical interventions and findings; and morbidity and mortality were documented.
A total of 92 trauma patients who underwent a trauma laparotomy met the inclusion criteria. Of these patients, 71 % were male. Median age was 37 years. Median ISS was 27. Mechanisms of injury comprised of car accidents (20 %), fall from height (17 %), motorcycle accidents (12 %), pedestrian/cyclist hit by a vehicle (9 %) and other in three patients (5 %). Penetrating injuries accounted for 37 % of the injuries, consisting of stab wounds (21 %) and gunshot wounds (16 %). Complications classified by the Clavien-Dindo Classification of Surgical Complications showed grade I complications in 21 patients (23 %), grade II in 36 patients (39 %), grade III in 21 patients (23 %), grade IV in 2 patients (2 %) and grade V in 16 patients (17 %).
Laparotomy for trauma has a high complication rate resulting in significant morbidity and mortality. Most events occur in the early postoperative period. Further prospective research needs to be conducted in order to identify possibilities to improve care in the future.
剖腹手术是创伤性腹部损伤后一种可能挽救生命的手术。关于创伤剖腹手术后发病率和死亡率的文献有限。本研究的主要目的是描述因创伤剖腹手术可能发生的并发症。
在荷兰的一家一级创伤中心进行了一项回顾性评估的单中心研究，对初次创伤剖腹手术后长达1年的数据进行登记。2000年1月至2011年1月期间，共有2390例重伤创伤患者（损伤严重度评分[ISS]≥16）被转运至VUMC。记录了患者的人口统计学数据；损伤机制；由简明损伤定级标准（AIS）、损伤严重度评分（ISS）和修订创伤评分（RTS）定义的损伤模式；手术干预和发现；以及发病率和死亡率。
共有92例接受创伤剖腹手术的创伤患者符合纳入标准。在这些患者中，71%为男性。中位年龄为37岁。中位ISS为27。损伤机制包括车祸（20%）、高处坠落（17%）、摩托车事故（12%）、行人/骑自行车者被车辆撞击（9%）以及其他3例（5%）。穿透性损伤占损伤的37%，包括刺伤（21%）和枪伤（16%）。根据手术并发症的Clavien-Dindo分类法分类的并发症显示，21例患者（23%）为I级并发症，36例患者（39%）为II级，21例患者（23%）为III级，2例患者（2%）为IV级，16例患者（17%）为V级。
创伤剖腹手术并发症发生率高，导致显著的发病率和死亡率。大多数事件发生在术后早期。需要进行进一步的前瞻性研究，以确定未来改善护理的可能性。
