Kong Victor, Oosthuizen George, Sartorius Benn, Clarke Damian
Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Pietermaritzburg, South Africa.
Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Injury. 2015 Sep;46(9):1753-8. doi: 10.1016/j.injury.2015.01.004. Epub 2015 Jan 15.
The selective non-operative management (SNOM) of stab injuries of the anterior abdomen is well established, but its application to the posterior abdomen remains controversial.
A retrospective review of 1013 patients was undertaken at a major trauma service in South Africa over a five-year period.
Ninety per cent of patients were males, and the mean age was 25 years. The mean time from injury to presentation was 4h and 73% of all injuries were inflicted by knives. A total of 9% (93) of patients required a laparotomy [Group A] and 82% (833) were successfully observed without the need for operative intervention [Group B]. CT imaging was performed on 52 patients (5%) who had haematuria [Group C], 25 (3%) who had neurological deficits [Group D], and 10 (1%) with retained weapon injuries [Group E]. The accuracy of physical examination for identifying the presence of organ injury was 88%. All observed patients who required laparotomy declared themselves within 24h. There were no mortalities as direct result of our current management protocol.
Selective management based on active clinical observation and serial physical examination is safe, and when coupled with the judicious use of advanced imaging, is a prudent and reliable approach in a resource constrained environment.
前腹部刺伤的选择性非手术治疗（SNOM）已得到充分确立，但其在后腹部的应用仍存在争议。
在南非一家主要创伤中心对1013例患者进行了为期五年的回顾性研究。
90%的患者为男性，平均年龄25岁。受伤至就诊的平均时间为4小时，73%的损伤由刀具造成。共有9%（93例）患者需要剖腹手术[甲组]，82%（833例）患者成功接受观察，无需手术干预[乙组]。对52例（5%）有血尿的患者[丙组]、25例（3%）有神经功能缺损的患者[丁组]和10例（1%）有遗留武器伤的患者[戊组]进行了CT成像检查。体格检查识别器官损伤的准确率为88%。所有接受观察且需要剖腹手术的患者均在24小时内明确诊断。目前的治疗方案没有导致直接死亡病例。
基于积极临床观察和系列体格检查的选择性治疗是安全的，在资源有限的环境中，结合合理使用先进影像学检查，是一种谨慎可靠的方法。
