腹腔镜手术在稳定血流动力学的腹部创伤患者中的作用：单一级别 I 创伤中心，倾向评分匹配研究。
Role of laparoscopic surgery in managing hemodynamically stable abdominal trauma patients: a single level I trauma center, propensity score matching study.
机构信息
Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Surgery, Armed Forces Capital Hospital, 81 Saemaeulro 177 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13574, Republic of Korea.
出版信息
Eur J Trauma Emerg Surg. 2024 Oct;50(5):2517-2525. doi: 10.1007/s00068-024-02642-4. Epub 2024 Sep 3.
BACKGROUND
The role of laparoscopy in the treatment and diagnosis of penetrating thoraco-abdominal injury has been established. However, there is no clear consensus on the role of laparoscopy in blunt injury due to numerous reasons, such as concerns of missed injury and technical problems in treating various abdominal organs. This study aimed to determine the feasibility of laparoscopy and evaluate its safety in managing blunt and penetrating abdominal trauma.
METHODS
The medical records and Korean Trauma Data Base (KTDB) of patients who underwent abdominal surgery from January 2018 to December 2022 at a single level I center were collected. Patients were classified into a laparoscopy group and a laparotomy group. The laparoscopy groups were matched 1:1 with the laparotomy group by using propensity score matching (PSM). Patient demographics, injured organ and its grade, operative procedure, and postoperative outcomes were evaluated and compared between the two groups.
RESULTS
After propensity score matching, 128 patients were included. There was no significant imbalance in demographics between the two groups except sex. Injured organ and its grade showed no significant differences between the two groups except for the incidence of omentum. Small bowel and mesenteric repair were performed most often in both groups. Splenectomy, pancreatic surgery, duodenectomy, and liver resection were performed exclusively in the laparotomy group. Severe postoperative complication rate (3% vs. 20%: p = 0.004), length of stay in ICU (3.3 ± 3.2 days vs. 4.6 ± 3.7; p = 0.046), and operation time (93.9 ± 47.7 min vs. 112.8 ± 57.7; p = 0.046) were significantly lower in the laparoscopy group. The conversion rate was about 16%. There was no missed injury.
CONCLUSIONS
In hemodynamically stable abdominal trauma patients who sustained penetrating or blunt injury, laparoscopy is feasible and safe as a diagnostic and therapeutic modality in selected cohort of abdominal trauma.
背景
腹腔镜在穿透性胸腹损伤的治疗和诊断中的作用已得到确立。然而，由于多种原因，例如对遗漏损伤的担忧以及治疗各种腹部器官的技术问题，腹腔镜在钝性损伤中的作用尚未达成明确共识。本研究旨在确定腹腔镜的可行性，并评估其在管理钝性和穿透性腹部创伤中的安全性。
方法
收集了 2018 年 1 月至 2022 年 12 月在一家一级中心接受腹部手术的患者的病历和韩国创伤数据库（KTDB）。患者分为腹腔镜组和剖腹手术组。使用倾向评分匹配（PSM）对腹腔镜组进行 1:1 匹配与剖腹手术组匹配。评估并比较两组患者的人口统计学特征、受伤器官及其分级、手术过程和术后结果。
结果
在进行倾向评分匹配后，纳入了 128 名患者。两组患者的人口统计学特征除性别外均无显著差异。两组受伤器官及其分级无显著差异，除网膜发生率外。两组最常进行小肠和肠系膜修复。脾切除术、胰腺手术、十二指肠切除术和肝切除术仅在剖腹手术组中进行。严重术后并发症发生率（3% vs. 20%：p=0.004）、ICU 住院时间（3.3±3.2 天 vs. 4.6±3.7 天：p=0.046）和手术时间（93.9±47.7 分钟 vs. 112.8±57.7 分钟：p=0.046）显著较低在腹腔镜组。转换率约为 16%。没有遗漏损伤。
结论
在血流动力学稳定的腹部创伤患者中，对于穿透性或钝性损伤，腹腔镜作为一种诊断和治疗方法是可行且安全的，适用于特定的腹部创伤患者群体。
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