Marx J A
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina.
Emerg Med Clin North Am. 1993 Feb;11(1):125-35.
Penetrating trauma of the abdomen no longer warrants automatic laparotomy. Reasonably accurate clinical predictors of the need for operation should first be employed. Patients who do not meet these clinical criteria undergo a selective diagnostic approach on the basis of mechanism and site of injury and the experience and expertise of the respective institution. The desire to avoid unnecessary laparotomy is laudable. Nevertheless marked morbidity or mortality caused by failure to conduct laparotomy in a timely manner can be a dreaded consequence. When clinical and diagnostic studies are unable to resolve the presence or severity of injury, laparotomy is often more prudent than expectant observation.
腹部穿透伤不再需要常规进行剖腹手术。首先应采用对手术需求有合理准确预测性的临床指标。不符合这些临床标准的患者，应根据损伤机制、部位以及各机构的经验和专业水平，采取选择性诊断方法。避免不必要剖腹手术的想法是值得称赞的。然而，因未能及时进行剖腹手术而导致的显著发病率或死亡率可能是可怕的后果。当临床和诊断检查无法明确损伤的存在或严重程度时，剖腹手术往往比期待性观察更为审慎。
