Ivatury R R, Simon R J, Stahl W M
Department of Surgery, Lincoln Medical and Mental Health Center, New York Medical College, Bronx 10451.
Surg Endosc. 1994 May;8(5):366-9; discussion 369-70. doi: 10.1007/BF00642432.
The role of laparoscopy in the selective management of gunshot wounds (GSW) of the abdomen was prospectively investigated in 38 patients. All the patients were hemodynamically stable and had equivocal evidence of intraabdominal penetration. Laparoscopy was performed in the operating room under anesthesia. The site of penetration was in the thoracoabdominal area in 13, epigastrium in 7, and lower quadrants in 18. Twenty-three (60.5%) had nonpenetration on laparoscopy and a laparotomy was avoided. The remaining patients had injuries to the liver (4 patients), spleen (two patients), diaphragm (3 patients), hemoperitoneum or retroperitoneal hematoma (6 patients), and hollow viscus injuries (5 patients). Laparoscopy was also helpful in determining the need for laparotomy vs thoracotomy in lower chest wounds. The negative laparoscopy group (no penetration) had a significantly lower hospital stay compared to hemodynamically stable patients who had negative laparotomy without laparoscopy for nonpenetrating GSW. There were no complications related to laparoscopy. Laparoscopy is a useful modality in the evaluation of hemodynamically stable patients with abdominal missile wounds.
对38例患者前瞻性研究了腹腔镜检查在腹部枪伤（GSW）选择性处理中的作用。所有患者血流动力学稳定，有腹部穿透的可疑证据。腹腔镜检查在手术室麻醉下进行。穿透部位位于胸腹区域13例，上腹部7例，下腹部18例。23例（60.5%）腹腔镜检查未发现穿透，避免了开腹手术。其余患者有肝脏损伤（4例）、脾脏损伤（2例）、膈肌损伤（3例）、血腹或腹膜后血肿（6例）以及中空脏器损伤（5例）。腹腔镜检查还有助于确定下胸部伤口是需要开腹手术还是开胸手术。与血流动力学稳定但未行腹腔镜检查而行阴性剖腹探查的非穿透性GSW患者相比，腹腔镜检查阴性组（无穿透）的住院时间显著缩短。未发生与腹腔镜检查相关的并发症。腹腔镜检查是评估血流动力学稳定的腹部火器伤患者的一种有用方法。
