Wu Chien, Lin Keng-Li, Chang Yin-Jen, Lin Heng-Fu
Division of Trauma, Department of Surgery, Far Eastern Memorial Hospital, No. 21, Section 2, Nan-Ya S. Rd., New Taipei City, Taiwan, Republic of China.
Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan, Republic of China.
Surg Endosc. 2023 Dec;37(12):9173-9182. doi: 10.1007/s00464-023-10487-y. Epub 2023 Oct 14.
In this retrospective cohort study, we assessed the utility of laparoscopic surgery for diagnostic and therapeutic purposes in patients with anterior abdominal stab wounds (AASWs). We also investigated patient characteristics that might suggest a greater suitability of laparoscopic interventions.
Over a 25-year span, we analyzed AASW patients who had operations, categorizing them based on the presence of significant intra-abdominal injuries and whether they received laparoscopic surgery or laparotomy. We compared variables such as preoperative conditions, surgical details, and postoperative outcomes. We further evaluated the criteria indicating the necessity of direct laparotomies and traits linked to overlooked injuries in laparoscopic surgeries.
Of 142 AASWs surgical patients, laparoscopic surgery was conducted on 89 (62.7%) patients. Only 2 (2.2%) had overlooked injuries after the procedure. Among patients without significant injuries, those receiving laparoscopic surgery had less blood loss than those receiving laparotomy (30.0 vs. 150.0 ml, p = 0.004). Patients who underwent laparoscopic surgery also had shorter hospital stays (significant injuries: 6.0 vs. 11.0 days, p < 0.001; no significant injuries: 5.0 vs. 6.5 days, p = 0.014). Surgical complications and overlooked injury rates were comparable between both surgical methods. Bowel evisceration correlated with higher laparotomy odds (odds ratio = 16.224, p < 0.001), while omental evisceration did not (p = 0.107).
Laparoscopy is a safe and effective method for patients with AASWs, fulfilling both diagnostic and therapeutic needs. For stable AASW patients, laparoscopy could be the preferred method, reducing superfluous nontherapeutic laparotomies.
在这项回顾性队列研究中，我们评估了腹腔镜手术在诊断和治疗前腹壁刺伤（AASW）患者中的效用。我们还调查了可能提示腹腔镜干预更适合的患者特征。
在25年的时间跨度内，我们分析了接受手术的AASW患者，根据是否存在严重腹腔内损伤以及他们接受的是腹腔镜手术还是开腹手术对他们进行分类。我们比较了术前情况、手术细节和术后结果等变量。我们进一步评估了表明直接开腹必要性的标准以及与腹腔镜手术中漏诊损伤相关的特征。
在142例接受手术的AASW患者中，89例（62.7%）接受了腹腔镜手术。术后只有2例（2.2%）存在漏诊损伤。在无严重损伤的患者中，接受腹腔镜手术的患者失血量少于接受开腹手术的患者（30.0 vs. 150.0 ml，p = 0.004）。接受腹腔镜手术的患者住院时间也更短（严重损伤：6.0 vs. 11.0天，p < 0.001；无严重损伤：5.0 vs. 6.5天，p = 0.014）。两种手术方法的手术并发症和漏诊损伤率相当。肠管脱出与开腹手术几率较高相关（优势比 = 16.224，p < 0.001），而网膜脱出则不然（p = 0.107）。
腹腔镜检查对于AASW患者是一种安全有效的方法，满足诊断和治疗需求。对于病情稳定的AASW患者，腹腔镜检查可能是首选方法，可减少不必要的非治疗性开腹手术。
