Mariadason J G, Parsa M H, Ayuyao A, Freeman H P
Department of Surgery, Harlem Hospital Center, New York, NY 10037.
Ann Surg. 1988 Mar;207(3):335-40. doi: 10.1097/00000658-198803000-00019.
We studied 324 patients admitted to Harlem Hospital Center from July 1981 to June 1986 with stab wounds of the thoracoabdominal region (area limited by a coronal circle through the fifth interspaces anteriorly and seventh interspaces posteriorly from above to a subcostal circle 5 cm caudad to the costal margins and 12th ribs from below). We divided this region into 12 zones (six symmetrical zones on each side) using the above upper and lower limits and the costal margins, the midlines, and the anterior and posterior axillary lines. This study was conducted to determine the incidence of transdiaphragmatic penetration for the thoracoabdominal region stab wounds in each of the 12 zones identified for the first time and applied in this study, and the reliability and safety of surgical management based mainly on physical examination. The highest incidence of transdiaphragmatic penetration occurred in stab wounds of the left anterior lower thoracic zone (21.7%). The lowest incidence was 0% and the overall incidence was 11%. Physical examination was accurate in making the diagnosis in 95.4% of all cases and no mortality was associated with a delay in diagnosis that may have resulted from the serial physical examinations. We conclude that this method of selective operative management based on physical examinations is accurate and safe.
我们研究了1981年7月至1986年6月期间入住哈莱姆医院中心的324例胸腹区域刺伤患者（该区域的界定为：前方通过第五肋间、后方通过第七肋间的冠状圆，上方以此为界，下方至肋缘下方5厘米处的肋下圆及第十二肋骨）。我们利用上述上下界限、肋缘、中线以及腋前线和腋后线，将该区域划分为12个区（左右各6个对称区）。本研究旨在确定首次在本研究中界定的12个区中，胸腹区域刺伤经膈穿透的发生率，以及主要基于体格检查的手术治疗的可靠性和安全性。经膈穿透发生率最高的是左前下胸区刺伤（21.7%）。最低发生率为0%，总体发生率为11%。体格检查在所有病例中95.4%的诊断是准确的，且未因系列体格检查可能导致的诊断延迟而出现死亡病例。我们得出结论，这种基于体格检查的选择性手术治疗方法准确且安全。
