Trauma Unit, School of Clinical Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa.
Trauma Unit, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, South Africa.
S Afr J Surg. 2023 Sep;61(3):17-20.
Selective non-operative management (SNOM) is the current gold standard for the treatment of patients with penetrating neck trauma. The policy revolves around the liberal use of computed tomography angiography (CTA) in those patients who are haemodynamically stable, irrespective of the anatomical zone of injury, aiming at reducing the incidence of negative and non-therapeutic interventions and their potential complications.
A retrospective audit of results of patients who underwent immediate surgical exploration at the Chris Hani Baragwanath Academic Hospital in Soweto between January 2010 and December 2015 was performed.
One-hundred and forty-five (145) patients, with a median age of 28 years (range 18-67 years), predominantly males (93.8%), underwent immediate exploration. Most injuries were caused by stab wounds (92.4%) and affected zone 2 (54.1%) on the left side of the neck (69.6%). The most common presentations were active haemorrhage (29.4%), shock (24.1%) and expanding haematoma (15.1%). A major vascular injury was found in 40%, and aero-digestive organ injury in 19.3%. The rate of negative-non-therapeutic exploration in this cohort was 4.1%. Complications were recorded in 7.6%, and the overall mortality was 9.6% secondary to early uncontrolled haemorrhage, sepsis and occlusive strokes.
The utilisation of SNOM with strict criteria for selection of patients who require immediate surgical exploration versus investigations with CTA results in a low rate of non-therapeutic interventions.
选择性非手术治疗（SNOM）是目前治疗穿透性颈部创伤患者的金标准。该策略围绕着对血流动力学稳定的患者自由使用计算机断层血管造影（CTA）展开，无论损伤的解剖区域如何，旨在降低阴性和非治疗性干预及其潜在并发症的发生率。
对 2010 年 1 月至 2015 年 12 月期间在索韦托克里斯·哈尼·巴哈加万恩医院立即接受手术探查的患者的结果进行回顾性审核。
145 名（145 例）患者，中位年龄为 28 岁（范围 18-67 岁），主要为男性（93.8%），立即接受了探查。大多数损伤是由刺伤引起的（92.4%），且位于颈部左侧 2 区（54.1%）（69.6%）。最常见的表现为活动性出血（29.4%）、休克（24.1%）和血肿扩大（15.1%）。40%的患者发现有主要血管损伤，19.3%的患者有呼吸道/消化道器官损伤。在这一组中，非治疗性探查的阴性率为 4.1%。记录到 7.6%的并发症，总体死亡率为 9.6%，继发于早期无法控制的出血、脓毒症和闭塞性中风。
使用 SNOM 并严格选择需要立即手术探查的患者，而不是使用 CTA 进行检查，可降低非治疗性干预的发生率。
