Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Tallinn, Estonia.
Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):2023-2027. doi: 10.1007/s00068-021-01749-2. Epub 2021 Jul 26.
A selective nonoperative management (SNOM) of penetrating abdominal injuries (PAI) is a standard of care in numerous established trauma centers. However, available evidence supporting SNOM of PAI in European settings remains scarce. Thus, we performed a multi-center study at selected Northern European trauma centers to investigate the management and outcomes of PAI. We hypothesized that despite a low number of penetrating injuries in included trauma centers, SNOM is successfully utilized with outcomes comparable with trauma centers with a high number of PAI.
All adult patients admitted to participating trauma centers in the Northern European region with PAI between 1/2015 and 12/2016 were retrospectively reviewed. Primary outcomes were mortality and success rate of SNOM.
Overall, 119 patients were included. Median age was 38 (28-47) years. SNOM was initiated in 55 patients (46.0%) with 94.5% success rate. Three patients (5.5%) failed SNOM and had a delayed laparotomy with one gastric injury, one small bowel injury and one patient with a bleeding from mesentery. Overall mortality of the cohort was 5.0%. However, all patients in the SNOM group survived. Higher median ISS, median Abbreviated Injury Scale score of the abdomen, rate of combined anterior and posterior wounds, rate of in-hospital complications and longer hospital length of stay were observed in the immediate laparotomy group compared to the SNOM group.
SNOM of PAI is a safe practice even in regions with a low prevalence of penetrating injuries. The outcomes in our study are comparable with results from trauma centers treating larger numbers of patients with PAI.
在许多已建立的创伤中心，选择性非手术治疗（SNOM）穿透性腹部损伤（PAI）是一种标准的治疗方法。然而，在欧洲环境中支持 PAI 的 SNOM 的可用证据仍然很少。因此，我们在北欧选定的创伤中心进行了一项多中心研究，以调查 PAI 的管理和结果。我们假设，尽管纳入的创伤中心穿透性损伤数量较少，但 SNOM 仍能成功使用，且结果与 PAI 数量较高的创伤中心相当。
回顾性分析了 2015 年 1 月至 2016 年 12 月期间北欧参与的创伤中心收治的所有成年 PAI 患者。主要结局是死亡率和 SNOM 的成功率。
共有 119 名患者纳入研究。中位年龄为 38（28-47）岁。55 名患者（46.0%）开始进行 SNOM，成功率为 94.5%。3 名患者（5.5%）SNOM 失败，行延迟剖腹术，其中 1 例胃损伤，1 例小肠损伤，1 例肠系膜出血。该队列的总死亡率为 5.0%。然而，SNOM 组的所有患者均存活。与 SNOM 组相比，立即剖腹组的中位 ISS、腹部损伤严重程度评分、前后联合伤口率、院内并发症发生率和住院时间均较长。
即使在穿透性损伤发生率较低的地区，PAI 的 SNOM 也是一种安全的治疗方法。我们的研究结果与治疗更多 PAI 患者的创伤中心的结果相当。
