Patwardhan Utsav M, Erwin Casey R, Rooney Alexandra S, Campbell Bryan, Keller Benjamin, Krzyzaniak Andrea, Bansal Vishal, Sise Michael J, Krzyzaniak Michael J, Ignacio Romeo C
Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA; Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA.
Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA; Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA.
J Pediatr Surg. 2025 Feb;60(2):161983. doi: 10.1016/j.jpedsurg.2024.161983. Epub 2024 Oct 11.
In stable children with penetrating abdominal trauma, literature regarding the use of laparoscopy (LAP) remains limited. Given increasing evidence in favor of LAP for selective adult trauma patients, we reviewed contemporary practices and outcomes in pediatric trauma patients.
The American College of Surgeons (ACS) Trauma Quality Programs data was utilized to identify children (<18 years) from 2016 to 2021 with a penetrating abdominal injury who underwent surgery within 24 h of admission. Patients with non-abdominal abbreviated injury score (AIS) ≥3, Glasgow Coma Scale (GCS) < 13, or instability using a shock index pediatric adjusted (SIPA) cutoff were excluded. Patients were compared based on whether they had LAP, open, or laparoscopic converted to open (LCO) exploration. Primary outcomes were length of stay (LOS) and complications, including missed injuries.
Among 1945 patients who underwent abdominal surgery for penetrating trauma, 32% were stabbed and 68% had gunshot wounds (GSW). LAP occurred in 235 (12%) and LCO in 145 (7.4%) patients. The proportion of LAP did not change over the study period. LAP was used more in patients presenting with stab wounds than GSW (24 vs. 7%, p < .01). There was higher use of LAP at pediatric centers (p < .01). Although there was no difference in mortality or complications by operative type, open patients were more severely injured, had a longer LOS (p < .01), and had more subsequent procedures (11% of open, 2 % LAP, 7% LCO, p < .01).
In stable children with penetrating abdominal trauma, LAP is most often utilized after stabbing and at pediatric trauma centers, but its overall use remains uncommon. LAP patients had lower rates of subsequent procedures and no increase in unexpected operations suggesting low rates of missed injuries. Criteria are needed to identify stable patients presenting after penetrating trauma who can benefit from a LAP approach.
III.
对于腹部穿透伤病情稳定的儿童，有关腹腔镜检查（LAP）应用的文献仍然有限。鉴于越来越多的证据支持对部分成年创伤患者使用腹腔镜检查，我们回顾了儿科创伤患者的当代治疗方法及治疗结果。
利用美国外科医师学会（ACS）创伤质量项目数据，确定2016年至2021年间18岁以下因腹部穿透伤在入院后24小时内接受手术的儿童。非腹部简明损伤分级（AIS）≥3、格拉斯哥昏迷量表（GCS）<13或使用儿童调整休克指数（SIPA）临界值判定为不稳定的患者被排除。根据患者接受的是腹腔镜检查、开放手术还是腹腔镜转为开放手术（LCO）进行比较。主要结局指标为住院时间（LOS）和并发症，包括漏诊损伤。
在1945例因穿透伤接受腹部手术的患者中，32%为刺伤，68%为枪伤（GSW）。235例（12%）患者接受了腹腔镜检查，145例（7.4%）患者接受了腹腔镜转为开放手术。在研究期间，腹腔镜检查的比例没有变化。与枪伤患者相比，刺伤患者更多地接受了腹腔镜检查（24%对7%，p<.01）。儿科中心腹腔镜检查的使用率更高（p<.01）。尽管不同手术方式的死亡率或并发症无差异，但接受开放手术的患者受伤更严重，住院时间更长（p<.01），后续手术更多（开放手术患者为11%，腹腔镜检查患者为2%，腹腔镜转为开放手术患者为7%，p<.01）。
对于腹部穿透伤病情稳定的儿童，腹腔镜检查最常用于刺伤后以及儿科创伤中心，但总体应用并不常见。接受腹腔镜检查的患者后续手术率较低，且意外手术未增加，提示漏诊损伤率较低。需要制定标准来识别穿透伤后病情稳定且能从腹腔镜检查方法中获益的患者。
III级
