Lee Yu Jin, Jeong Soon Tak, Kim Joongsuck, Yeo Kwanghee, Kwon Ohsang, Kim Kyounghwan, Park Sung Jin, Gwak Jihun, Kang Wu Seong
Department of Emergency Medicine, Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju, Korea.
Department of Physical Medicine and Rehabilitation, Ansanhyo Hospital, Ansan, Korea.
J Trauma Inj. 2024 Mar;37(1):20-27. doi: 10.20408/jti.2023.0072. Epub 2024 Jan 12.
Severe abdominal injuries often require immediate clinical assessment and surgical intervention to prevent life-threatening complications. In Jeju Regional Trauma Center, we have instituted a protocol for emergency department (ED) laparotomy at the trauma bay. We investigated the mortality and time taken from admission to ED laparotomy.
We reviewed the data recorded in our center's trauma database between January 2020 and December 2022 and identified patients who underwent laparotomy because of abdominal trauma. Laparotomies that were performed at the trauma bay or the ED were classified as ED laparotomy, whereas those performed in the operating room (OR) were referred to as OR laparotomy. In cases that required expeditious hemostasis, ED laparotomy was performed appropriately.
From January 2020 to December 2022, 105 trauma patients admitted to our hospital underwent emergency laparotomy. Of these patients, six (5.7%) underwent ED laparotomy. ED laparotomy was associated with a mortality rate of 66.7% (four of six patients), which was significantly higher than that of OR laparotomy (17.1%, 18 of 99 patients, P=0.006). All the patients who received ED laparotomy also underwent damage control laparotomy. The time between admission to the first laparotomy was significantly shorter in the ED laparotomy group (28.5 minutes; interquartile range [IQR], 14-59 minutes) when compared with the OR laparotomy group (104 minutes; IQR, 88-151 minutes; P<0.001). The two patients who survived after ED laparotomy had massive mesenteric bleeding, which was successfully ligated. The other four patients, who had liver laceration, kidney rupture, spleen injury, and pancreas avulsion, succumbed to the injuries.
Although ED laparotomy was associated with a higher mortality rate, the time between admission and ED laparotomy was markedly shorter than for OR laparotomy. Notably, major mesenteric hemorrhages were effectively controlled through ED laparotomy.
严重腹部损伤通常需要立即进行临床评估和手术干预，以预防危及生命的并发症。在济州地区创伤中心，我们制定了一项在创伤区进行急诊科（ED）剖腹手术的方案。我们调查了死亡率以及从入院到进行ED剖腹手术所需的时间。
我们回顾了2020年1月至2022年12月期间在本中心创伤数据库中记录的数据，并确定了因腹部创伤而接受剖腹手术的患者。在创伤区或急诊科进行的剖腹手术归类为ED剖腹手术，而在手术室（OR）进行的剖腹手术则称为OR剖腹手术。在需要迅速止血的情况下，适当进行ED剖腹手术。
2020年1月至2022年12月期间，我院收治的105例创伤患者接受了急诊剖腹手术。其中，6例（5.7%）接受了ED剖腹手术。ED剖腹手术的死亡率为66.7%（6例患者中的4例），显著高于OR剖腹手术的死亡率（17.1%，99例患者中的18例，P=0.006）。所有接受ED剖腹手术的患者还接受了损伤控制剖腹手术。与OR剖腹手术组（104分钟；四分位间距[IQR]，88-151分钟；P<0.001）相比，ED剖腹手术组从入院到首次剖腹手术的时间明显更短（28.5分钟；IQR，14-59分钟）。ED剖腹手术后存活的2例患者出现大量肠系膜出血，成功进行了结扎。其他4例患者分别有肝裂伤、肾破裂、脾损伤和胰腺撕脱伤，均因伤死亡。
虽然ED剖腹手术的死亡率较高，但从入院到ED剖腹手术的时间明显短于OR剖腹手术。值得注意的是，通过ED剖腹手术能有效控制主要肠系膜出血。
