Zantut L F, Ivatury R R, Smith R S, Kawahara N T, Porter J M, Fry W R, Poggetti R, Birolini D, Organ C H
Department of Surgery, University of Sao Paulo, Brazil.
J Trauma. 1997 May;42(5):825-9; discussion 829-31. doi: 10.1097/00005373-199705000-00012.
Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation of penetrating abdominal trauma. The reported experience with therapeutic laparoscopy has been limited.
Retrospective analysis of a collective experience from three large urban trauma centers with 510 patients (316 stab wounds, 194 gunshot wounds) who were hemodynamically stable and had no urgent indications for celiotomy.
Laparotomy was avoided in 277 of the 510 patients (54.3%) either because of nonpenetration or insignificant findings on laparoscopy. All were discharged uneventfully after a mean hospital stay of 1.7 days. Twenty-six had successful therapeutic procedures on laparoscopy (diaphragmatic repair in 16 patients, cholecystectomy in 1 patient, hepatic repair in 6 patients, and closure of gastrotomy in 3 patients) with uneventful recovery. In the remaining 203 patients, laparotomy was therapeutic in 155. Fifty-two patients had nontherapeutic celiotomy for exclusion of bowel injuries or as mandatory laparotomy for penetrating gunshot wounds (19.7%). The overall incidence of nontherapeutic laparotomy was 10.2%. Complications from laparoscopy were minimal (10 of 510) and minor.
Laparoscopy has an important diagnostic role in stable patients with penetrating abdominal trauma. In carefully selected patients, therapeutic laparoscopy is practical, feasible, and offers all the advantages of minimally invasive surgery.
对于诊断性腹腔镜检查在评估穿透性腹部创伤中的作用，仍存在相当多的质疑。关于治疗性腹腔镜检查的报道经验有限。
对三个大型城市创伤中心的510例患者（316例刺伤，194例枪伤）的集体经验进行回顾性分析，这些患者血流动力学稳定，且无紧急剖腹手术指征。
510例患者中有277例（54.3%）避免了剖腹手术，原因是未穿透或腹腔镜检查结果不显著。所有患者平均住院1.7天后均顺利出院。26例患者在腹腔镜检查中进行了成功的治疗性手术（16例膈肌修复，1例胆囊切除术，6例肝脏修复，3例胃切开术闭合），恢复顺利。在其余203例患者中，155例进行了治疗性剖腹手术。52例患者进行了非治疗性剖腹手术以排除肠道损伤或作为穿透性枪伤的强制性剖腹手术（19.7%）。非治疗性剖腹手术的总体发生率为10.2%。腹腔镜检查的并发症极少（510例中有10例）且轻微。
腹腔镜检查在血流动力学稳定的穿透性腹部创伤患者中具有重要的诊断作用。在精心挑选的患者中，治疗性腹腔镜检查切实可行，具有微创手术的所有优点。
Zotero 插件