Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas, University of Sao Paulo, São Paulo, Brazil.
Department of Radiology, Hospital das Clínicas, University of Sao Paulo, São Paulo, Brazil.
Surg Endosc. 2020 Jan;34(1):261-267. doi: 10.1007/s00464-019-06761-7. Epub 2019 Apr 8.
Management of patients with thoracoabdominal penetrating injuries is challenging. Thoracoabdominal penetrating trauma may harbor hollow viscus injuries in both thoracic and abdominal cavities and occult diaphragmatic lesions. While radiological tests show poor diagnostic performance in these situations, evaluation by laparoscopy is highly sensitive and specific. Furthermore, minimally invasive surgery may avoid unnecessary laparotomies, despite concerns regarding complication and missed injury rates. The objective of the present study is to evaluate the diagnostic and therapeutic performance of laparoscopy in stable patients with thoracoabdominal penetrating injuries.
Retrospective analysis of hemodynamically stable patients with thoracoabdominal penetrating wounds was managed by laparoscopy. We collected data regarding the profile of the patients, the presence of diaphragmatic injury, perioperative complications, and the conversion rate. Preoperative imaging tests were compared to laparoscopy in terms of diagnostic accuracy.
Thirty-one patients were included, and 26 (84%) were victims of a stab wound. Mean age was 32 years. Ninety-three percent were male. Diaphragmatic lesions were present in 18 patients (58%), and 13 (42%) had associated injuries. There were no missed injuries and no conversions. Radiography and computerized tomography yielded an accuracy of 52% and 75%, respectively.
Laparoscopy is a safe diagnostic and therapeutic procedure in stable patients with thoracoabdominal penetrating wound, with low complication rate, and may avoid unnecessary laparotomies. The poor diagnostic performance of preoperative imaging exams supports routine laparoscopic evaluation of the diaphragm to exclude injuries in these patients.
胸腹部贯通伤的处理具有挑战性。胸腹部贯通伤可能同时存在胸腔和腹腔的空腔脏器损伤和隐匿性膈损伤。虽然影像学检查在这些情况下的诊断性能较差，但腹腔镜检查具有高度的敏感性和特异性。此外，尽管微创手术可能会避免不必要的剖腹手术，但仍存在并发症和漏诊率的担忧。本研究的目的是评估腹腔镜检查在稳定型胸腹部贯通伤患者中的诊断和治疗性能。
回顾性分析稳定型胸腹部贯通伤患者的腹腔镜处理。我们收集了患者的基本资料、膈损伤情况、围手术期并发症和中转开腹率等数据。并将术前影像学检查与腹腔镜检查的诊断准确性进行比较。
共纳入 31 例患者，其中 26 例（84%）为锐器刺伤。患者平均年龄为 32 岁，93%为男性。18 例（58%）患者存在膈损伤，13 例（42%）存在合并损伤。无漏诊和中转开腹。X 线和 CT 检查的准确率分别为 52%和 75%。
腹腔镜检查是稳定型胸腹部贯通伤患者安全的诊断和治疗方法，并发症发生率低，可避免不必要的剖腹手术。术前影像学检查的诊断性能较差，支持对这些患者常规进行腹腔镜膈肌评估以排除损伤。
