Weigelt J A, Kingman R G
Department of Surgery, Southwestern Medical School, University of Texas Health Science Center, Dallas 75235-9031.
Am J Surg. 1988 Dec;156(6):544-7. doi: 10.1016/s0002-9610(88)80549-x.
Controversy continues about how often a negative laparotomy should be accepted in the management of patients with blunt and penetrating trauma. A key issue is the complications, especially small bowel obstruction. To define these complications, the charts of 248 patients who underwent negative laparotomy for trauma were examined. There were 185 patients with penetrating injuries and 63 with blunt injuries. Associated injuries were present in 119 patients. Acute perioperative morbidity occurred in 53 percent of the patients with associated injuries and 22 percent of patients with no associated injuries. On long-term follow-up, five patients developed small bowel obstructions. The incidence of small bowel obstruction was related to operative exposure. We have concluded that early morbidity after a negative laparotomy is more common when associated injuries are present. The risk of postoperative small bowel obstruction is small, especially when extensive operative dissection is not necessary. Abdominal exploration should not be discarded as a viable diagnostic and therapeutic procedure in patients with equivocal findings.
对于钝性和穿透性创伤患者的处理中，阴性剖腹探查术应被接受的频率仍存在争议。一个关键问题是并发症，尤其是小肠梗阻。为了明确这些并发症，我们检查了248例因创伤接受阴性剖腹探查术患者的病历。其中185例为穿透伤患者，63例为钝性伤患者。119例患者存在合并伤。合并伤患者围手术期急性发病率为53%，无合并伤患者为22%。长期随访中，5例患者发生小肠梗阻。小肠梗阻的发生率与手术暴露有关。我们得出结论，存在合并伤时，阴性剖腹探查术后早期发病率更常见。术后小肠梗阻的风险较小，尤其是在不需要广泛手术解剖时。对于检查结果不明确的患者，腹部探查不应被视为不可行的诊断和治疗方法而被摒弃。
