Liagkos Georgios Theodoros, Spyropoulos Charalampos, Tsourouflis Gerasimos, Papadopoulos Aris, Ioannides Paulos, Vagianos Constantine
1st Department of Surgery, Nikaia General Hospital, Nikaia, Piraeus-Greece.
Ulus Travma Acil Cerrahi Derg. 2018 Mar;24(2):104-109. doi: 10.5505/tjtes.2017.83404.
The non-operative management (NOM) of abdominal injuries has gained wide acceptance over the last few decades. The present study evaluated the efficacy of NOM in blunt abdominal trauma (BAT) at a regional Hellenic hospital.
We analyzed the results of a pre-decided treatment protocol, which was applied to all patients hospitalized for BAT, from 2008 to 2015. The protocol proposed NOM in hemodynamically stable patients with no signs of peritonitis. The demographic characteristics, type of injury, injured organ(s), type of management (operative vs. non-operative), Injury Severity Score (ISS), morbidity, mortality rates, and health costs were evaluated.
One hundred and forty-six patients hospitalized for BAT at our department were included. Among them, 49 were operated and 97 were subjected to NOM. Although ISS was significantly higher in the surgical group, the severity of injuries in liver, spleen, and kidneys was not different between the two groups. Surprisingly, no case subjected to NOM required a conversion to operative management, which may probably be because of the strict inclusion criteria for NOM.
Patients with hemodynamic stability and normal physical examination may be non-operatively treated, independent of the grade of injury, in highly selective cases. ISS score is an independent risk factor for surgical treatment.
在过去几十年中，腹部损伤的非手术治疗（NOM）已获得广泛认可。本研究评估了希腊一家地区医院中NOM在钝性腹部创伤（BAT）中的疗效。
我们分析了一项预先确定的治疗方案的结果，该方案应用于2008年至2015年期间因BAT住院的所有患者。该方案建议对血流动力学稳定且无腹膜炎体征的患者采用NOM。评估了人口统计学特征、损伤类型、受伤器官、治疗类型（手术与非手术）、损伤严重程度评分（ISS）、发病率、死亡率和医疗费用。
我们科室收治的146例因BAT住院的患者被纳入研究。其中，49例行手术治疗，97例接受NOM。虽然手术组的ISS显著更高，但两组肝脏、脾脏和肾脏的损伤严重程度并无差异。令人惊讶的是，没有一例接受NOM的患者需要转为手术治疗，这可能是由于NOM的严格纳入标准所致。
在高度选择性的病例中，血流动力学稳定且体格检查正常的患者，无论损伤程度如何，均可采用非手术治疗。ISS评分是手术治疗的独立危险因素。
