Department of Gastrointestinal Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Department of Surgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
J Laparoendosc Adv Surg Tech A. 2021 Nov;31(11):1262-1268. doi: 10.1089/lap.2020.0552. Epub 2021 Jan 11.
Trauma is a leading cause of death in young patients. The prevalence of blunt and penetrating trauma varies widely across the globe. Similarly, the global experience with laparoscopy in trauma patients also varies. There is a growing body of evidence to suggest that laparoscopy is feasible in trauma patients. We sought to contribute to these data by reporting our experience with laparoscopic management of blunt and penetrating trauma in a Belgian center. We retrospectively collected data on all trauma patients admitted to the Saint-Pierre University Hospital in Brussels, Belgium, over the 4-year period from January 2014 to December 2017. Hospital records for patients subjected to exploratory laparoscopy were retrospectively reviewed, and a descriptive analysis was reported. There were 26 patients at a mean age of 40 years treated with laparoscopic exploration for injuries from blunt trauma (7), stab wounds (14), and gunshot injuries (5). The median interval between the arrival at the emergency unit and diagnostic laparoscopy was 175 minutes (range: 27-1440), and the median duration of operation was 119 minutes (range: 8-300). In all patients who underwent laparoscopy for trauma, there were 27% overall morbidity, no mortality, 11% reoperation rate, 7.4% conversions, and 19% incidence of negative laparoscopy. The median intensive care unit stay was 3 days (range: 0-41), and median total hospital stay was 7 days (range: 2-78). Laparoscopy is a safe, feasible, and effective tool in the surgical armamentarium to treat hemodynamically stable patients with blunt and penetrating abdominal trauma. It allows complete and thorough evaluation of intra-abdominal viscera, reduces the incidence of nontherapeutic operations, and allows therapeutic intervention to repair a variety of injuries. However, it requires appropriate surgeon training and experience with advanced laparoscopic techniques to ensure good outcomes.
创伤是年轻患者死亡的主要原因。在全球范围内，钝器伤和穿透伤的发生率差异很大。同样，全球范围内创伤患者腹腔镜治疗的经验也有所不同。越来越多的证据表明腹腔镜在创伤患者中是可行的。我们试图通过报告我们在比利时一家中心对钝器伤和穿透伤患者进行腹腔镜治疗的经验来为这些数据做出贡献。
我们回顾性地收集了 2014 年 1 月至 2017 年 12 月期间在比利时布鲁塞尔圣皮埃尔大学医院收治的所有创伤患者的病历数据。回顾性分析接受剖腹探查术的患者的病历，并进行描述性分析。
有 26 名患者平均年龄为 40 岁，因钝器伤（7 例）、刺伤（14 例）和枪伤（5 例）接受腹腔镜探查治疗。从到达急诊室到诊断性腹腔镜检查的中位数间隔为 175 分钟（范围：27-1440 分钟），手术中位数时间为 119 分钟（范围：8-300 分钟）。所有接受腹腔镜治疗的创伤患者中，总并发症发生率为 27%，无死亡率，再手术率为 11%，中转开腹率为 7.4%，阴性腹腔镜检查率为 19%。重症监护病房中位住院时间为 3 天（范围：0-41 天），总住院时间中位数为 7 天（范围：2-78 天）。
腹腔镜检查是治疗血流动力学稳定的钝器伤和穿透性腹部创伤患者的安全、可行和有效的手术工具。它允许对内脏进行全面彻底的评估，减少非治疗性手术的发生率，并允许进行治疗性干预以修复各种损伤。然而，它需要适当的外科医生培训和经验，掌握先进的腹腔镜技术，以确保良好的效果。
