Renz B M, Feliciano D V
Joseph B. Whitehead Department of Surgery, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia.
J Trauma. 1994 Nov;37(5):737-44. doi: 10.1097/00005373-199411000-00007.
Dissatisified with our unnecessary laparotomy rate in patients with gunshot wounds (GSWs) to the right thoracoabdomen (RTA), a prospective study was designed to test the hypothesis that hemodynamically stable patients without peritonitis could be managed without a surgical procedure. From 1990 through 1993, 13 consecutive patients with a GSW between the right nipple, costal margin, right posterior axillary line, and anterior midline were studied. No patient had or developed more than local wound tenderness. All patients had a right hemothorax treated with a chest tube. Computed tomographic (CT) scanning of the RTA was performed within 8 hours of admission in 12 of the 13 patients, and the following injuries were noted: pulmonary contusion (12), hepatic laceration (seven), spinal cord transection (two), and a renal laceration (one). Follow-up CT scans, 3 to 14 days after injury, in six of the seven patients with hepatic wounds showed partial or complete resolution of the injury in all. In one patient, an associated renal injury was unchanged on the follow-up CT scan. Mean length of hospitalization for the 11 patients who did not have an injury to the spinal cord was 5.1 days (3-8 days). Complications included atelectasis (four), a small persistent pneumothorax (two), and pneumonia (one).(ABSTRACT TRUNCATED AT 250 WORDS)
由于对我们收治的右胸腹部枪伤（GSW）患者不必要的剖腹手术率不满意，我们设计了一项前瞻性研究，以检验以下假设：对于血流动力学稳定且无腹膜炎的患者，可以不通过手术进行治疗。1990年至1993年期间，我们研究了连续13例枪伤位于右乳头、肋缘、右腋后线和前正中线之间的患者。没有患者有或出现超过局部伤口压痛的情况。所有患者均通过胸腔闭式引流管治疗右侧血胸。13例患者中有12例在入院后8小时内进行了右胸腹部的计算机断层扫描（CT），发现了以下损伤：肺挫伤（12例）、肝裂伤（7例）、脊髓横断伤（2例）和肾裂伤（1例）。7例肝损伤患者中有6例在受伤后3至14天进行的随访CT扫描显示损伤部分或完全消退。1例患者，相关的肾损伤在随访CT扫描中无变化。11例无脊髓损伤的患者的平均住院时间为5.1天（3 - 8天）。并发症包括肺不张（4例）、小的持续性气胸（2例）和肺炎（1例）。（摘要截选至250字）
