Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
J Surg Res. 2024 Nov;303:14-21. doi: 10.1016/j.jss.2024.08.014. Epub 2024 Sep 16.
Diagnostic laparoscopy (DL) has been advocated to reduce the incidence of nontherapeutic laparotomies (NL) among stable trauma patients. This study aimed to compare the outcomes of hemodynamically stable trauma patients undergoing DL versus NL.
This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database over 4 y (2017-2020). Hemodynamically stable (systolic blood pressure >90 & heart rate < 120) adult (≥18 y) trauma patients undergoing DL or NL were included. Patients were stratified into DL and NL and substratified based on the mechanism of injury (blunt versus penetrating) and compared.
Over 4 y, 3801 patients were identified, of which, 997 (26.2%) underwent DL. Overall, 25.6% sustained blunt injuries. The mean (SD) age was 39 (16) and 79.5% were male. The median injury severity score and abdominal abbreviated injury scale were 4 [4-9] and 1 [1-2], with no difference among study groups (P ≥ 0.05). The overall mortality and major complication rates were 2.8% and 13.2%, respectively. After controlling for potential confounding factors, DL was independently associated with lower odds of mortality (adjusted odds ratio: 0.10, 95% CI [0.04-0.29], P < 0.001) and major complications (adjusted odds ratio: 0.38, 95% CI [0.29-0.50], P < 0.001) and shorter hospital length of stay (β: -1.22, 95% CI [-1.78 to -0.67], P < 0.001). The trends toward improved outcomes in the DL group remained the same in the subanalysis of patients with penetrating and blunt injuries.
With advances in minimally invasive surgery, unnecessary exploratory laparotomy can be avoided in many trauma patients. Our study shows that hemodynamically stable patients undergoing DL had superior outcomes compared to those with NL.
诊断性腹腔镜检查（DL）已被提倡用于减少稳定型创伤患者中非治疗性剖腹手术（NL）的发生率。本研究旨在比较行 DL 与 NL 的稳定型创伤患者的结局。
这是对美国外科医师学会创伤质量改进计划数据库进行的一项回顾性分析，时间跨度为 4 年（2017-2020 年）。纳入接受 DL 或 NL 的血流动力学稳定（收缩压>90mmHg 和心率<120 次/分）的成年（≥18 岁）创伤患者。患者分为 DL 和 NL 两组，并根据损伤机制（钝性与穿透性）进行分层比较。
在 4 年期间，共确定了 3801 例患者，其中 997 例（26.2%）接受了 DL。总体而言，25.6%的患者为钝性损伤。平均（SD）年龄为 39（16）岁，79.5%为男性。损伤严重程度评分和腹部损伤严重程度评分中位数分别为 4 [4-9] 和 1 [1-2]，各组间无差异（P≥0.05）。总的死亡率和主要并发症发生率分别为 2.8%和 13.2%。在控制了潜在混杂因素后，DL 与较低的死亡率（校正比值比：0.10，95%置信区间[0.04-0.29]，P<0.001）和主要并发症（校正比值比：0.38，95%置信区间[0.29-0.50]，P<0.001）和较短的住院时间（β：-1.22，95%置信区间[-1.78 至-0.67]，P<0.001）相关。在穿透性和钝性损伤患者的亚组分析中，DL 组的结局改善趋势仍然相同。
随着微创外科技术的进步，许多创伤患者可以避免不必要的剖腹探查术。本研究表明，血流动力学稳定的患者行 DL 的结局优于 NL。
