Malkomes Patrizia, Störmann Philipp, El Youzouri Hanan, Wutzler Sebastian, Marzi Ingo, Vogl Thomas, Bechstein Wolf Otto, Habbe Nils
Department of General and Visceral Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany.
Eur J Trauma Emerg Surg. 2019 Apr;45(2):315-321. doi: 10.1007/s00068-018-0911-1. Epub 2018 Jan 22.
Penetrating abdominal injuries caused by stabbing or firearms are rare in Germany, thus there is lack of descriptive studies. The management of hemodynamically stable patients is still under dispute. The aim of this study is to review and improve our management of penetrating abdominal injuries.
We retrospectively reviewed a 10-year period from the Trauma Registry of our level I trauma center. The data of all patients regarding demographics, clinical and outcome parameters were examined. Further, charts were reviewed for FAST and CT results and correlated with intraoperative findings.
A total of 115 patients with penetrating abdominal trauma (87.8% men) were analyzed. In 69 patients, the injuries were caused by interpersonal violence and included 88 stab and 4 firearm wounds. 8 patients (6.9%) were in a state of shock at presentation. 52 patients (44.8%) suffered additional extraabdominal injuries. 38 patients were managed non-operatively, while almost two-thirds of all patients underwent surgical treatment. Hereof, 20 laparoscopies and 3 laparotomies were nontherapeutic. There were two missed injuries, but no patient experienced morbidity or mortality related to delay in treatment. 106 (92.2%) FAST and 91 (79.3%) CT scans were performed. Sensitivity and specificity of FAST were 59.4 and 94.2%, while those of CT were 93.2 and 85.1%, respectively.
In hemodynamically stable patients presenting with penetrating abdominal trauma, CT is indicated and the majority of injuries can be managed conservatively. If surgical treatment is required, diagnostic laparoscopy for stable patients is feasible to avoid nontherapeutic laparotomy.
在德国，刺伤或火器造成的穿透性腹部损伤较为罕见，因此缺乏描述性研究。血流动力学稳定患者的治疗仍存在争议。本研究的目的是回顾并改进我们对穿透性腹部损伤的治疗。
我们回顾性分析了我院一级创伤中心创伤登记处10年期间的数据。检查了所有患者的人口统计学、临床和结局参数数据。此外，还查阅了快速超声（FAST）和计算机断层扫描（CT）结果的图表，并与术中发现进行了关联。
共分析了115例穿透性腹部创伤患者（男性占87.8%）。其中69例患者的损伤由人际暴力所致，包括88处刺伤和4处火器伤。8例患者（6.9%）就诊时处于休克状态。52例患者（44.8%）还伴有腹部外其他损伤。38例患者接受了非手术治疗，而几乎三分之二的患者接受了手术治疗。其中，20例腹腔镜检查和3例剖腹手术未发现病变。有2例漏诊损伤，但没有患者因治疗延迟而出现并发症或死亡。进行了106次（92.2%）FAST检查和91次（79.3%）CT扫描。FAST的敏感性和特异性分别为59.4%和94.2%，而CT的敏感性和特异性分别为93.2%和85.1%。
对于血流动力学稳定的穿透性腹部创伤患者，建议进行CT检查，大多数损伤可保守治疗。如果需要手术治疗，对于病情稳定的患者，诊断性腹腔镜检查可行，可避免不必要的剖腹手术。
