Oyo-Ita Angela, Chinnock Paul, Ikpeme Ikpeme A
Department of Community Health, University of Calabar Teaching Hospital, PMB 1278, Calabar, Nigeria.
Cochrane Database Syst Rev. 2015 Nov 13;2015(11):CD007383. doi: 10.1002/14651858.CD007383.pub3.
Injury to the abdomen can be blunt or penetrating. Abdominal injury can damage internal organs such as the liver, spleen, kidneys, intestine, and large blood vessels. There are controversies about the best approach to manage abdominal injuries.
To assess the effects of surgical and non-surgical interventions in the management of abdominal trauma in a haemodynamically stable and non-peritonitic abdomen.
We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic+EMBASE (Ovid), ISI WOS (SCI-EXPANDED, SSCI, CPCI-S & CPSI-SSH), CINAHL Plus (EBSCO), and clinical trials registers, and screened reference lists. We ran the most recent search on 17 September 2015.
Randomised controlled trials of surgical interventions and non-surgical interventions involving people with abdominal injury who were haemodynamically stable with no signs of peritonitis. The abdominal injury could be blunt or penetrating.
Two review authors independently applied the selection criteria. Data were extracted by two authors using a standard data extraction form, and are reported narratively.
Two studies are included, which involved a total of 114 people with penetrating abdominal injuries. Both studies are at moderate risk of bias because the randomisation methods are not fully described, and the original study protocols are no longer available. The studies were undertaken in Finland between 1992 and 2002, by the same two researchers.In one study, 51 people were randomised to surgery or an observation protocol. None of the participants in the study died. Seven people had complications: 5 (18.5%) in the surgical group and 2 (8.3%) in the observation group; the difference was not statistically significant (P = 0.42; Fischer's exact). Among the 27 people who had surgery, 6 (22.2%) surgeries were negative laparotomies, and 15 (55.6%) were non-therapeutic.In the other study, 63 people were randomised to diagnostic laparoscopy (surgery) or an observation protocol. There were no deaths and no unnecessary surgeries in either group. Four people did not receive the intervention they were assigned. There was no difference in therapeutic operations between the two groups: 3 of 28 in the diagnostic laparoscopy group versus 1 of 31 in the observation protocol group (P = 0.337).
AUTHORS' CONCLUSIONS: Based on the findings of 2 studies involving a total of 114 people, there is no evidence to support the use of surgery over an observation protocol for people with penetrating abdominal trauma who have no signs of peritonitis and are stable.
腹部损伤可以是钝性的或穿透性的。腹部损伤可损害肝脏、脾脏、肾脏、肠道和大血管等内部器官。关于处理腹部损伤的最佳方法存在争议。
评估手术和非手术干预措施对血流动力学稳定且无腹膜炎的腹部创伤患者的治疗效果。
我们检索了Cochrane损伤组专业注册库、Cochrane图书馆、Ovid MEDLINE(R)、Ovid MEDLINE(R)在研及其他未索引引文、Ovid MEDLINE(R)每日更新及Ovid OLDMEDLINE(R)、EMBASE经典版+EMBASE（Ovid）、ISI WOS（SCI-EXPANDED、SSCI、CPCI-S及CPSI-SSH）、CINAHL Plus（EBSCO）以及临床试验注册库，并筛选了参考文献列表。我们于2015年9月17日进行了最新检索。
涉及血流动力学稳定且无腹膜炎体征的腹部损伤患者的手术干预和非手术干预的随机对照试验。腹部损伤可以是钝性的或穿透性的。
两位综述作者独立应用入选标准。由两位作者使用标准数据提取表提取数据，并进行描述性报告。
纳入两项研究，共涉及114例穿透性腹部损伤患者。两项研究均存在中度偏倚风险，因为随机化方法未充分描述，且原始研究方案已不可用。这些研究由相同的两位研究人员于1992年至2002年在芬兰进行。在一项研究中，51例患者被随机分配至手术组或观察方案组。该研究中无参与者死亡。7例出现并发症：手术组5例（18.5%），观察组2例（8.3%）；差异无统计学意义（P = 0.42；Fisher精确检验）。在接受手术的27例患者中，6例（22.2%）手术为阴性剖腹探查术，15例（55.6%）为非治疗性手术。在另一项研究中，63例患者被随机分配至诊断性腹腔镜检查（手术）组或观察方案组。两组均无死亡病例及不必要的手术。4例患者未接受分配的干预措施。两组治疗性手术无差异：诊断性腹腔镜检查组28例中有3例，观察方案组31例中有1例（P = 0.337）。
基于两项共涉及114例患者的研究结果，对于无腹膜炎体征且病情稳定的穿透性腹部创伤患者，没有证据支持手术治疗优于观察方案。
