腹部刀刺伤手术63例诊治体会

目的探讨腹部刀刺伤的诊断及治疗。方法总结分析我院近5年63例腹部刀刺伤手术的诊断和治疗方法。结果治愈63例,死亡1例。结论休克、大网膜及腹腔脏器外脱、腹痛伴腹膜炎体征、诊断性腹腔穿刺阳性均是手术指征。复合复杂刀刺伤及时行CT检查有助于病情诊断。术中仔细探查腹腔脏器、避免漏诊漏治,是腹部刀刺伤的诊治关键。     

腹部刀刺伤63例临床分析

目的探讨腹部刀刺伤患者的诊断及治疗。方法回顾性分析近5年我院收治的腹部刀刺伤患者的治疗情况。结果63例腹部刀刺伤患者，腹壁清创缝合术3例，剖腹探查54例，保守治疗6例。治愈61例，死亡2例。结论对腹部刀刺伤应正确迅速地作出诊断，及时剖腹探查，术中仔细探查腹腔脏器，避免漏诊、漏治，是治疗腹部刀刺伤的诊治关键。     

腹部刀刺伤诊治体会(附147例报告)

目的：探讨腹部刀刺伤的诊断与治疗。方法：回顾性总结分析147例腹部刀刺伤患者的临床资料。结果：147例患者中，腹腔脏器从伤口脱出43例，其中大网膜脱出39例．小肠脱出1例，胃脱出1例，结肠脱出2例。伴失血性休克28例。全组病例中行剖腹探查手术139例，伤口清创缝合8例；治愈145例，死亡2例。结论：腹部刀刺伤合并休克，有大网膜及腹腔脏器外脱，腹痛伴腹膜炎体征，诊断性腹腔穿刺阳性均是手术指征。臀部刀刺伤要警惕损伤腹腔脏器。合并胸部伤或发生胸腹联合伤时，除有心脏大血管损伤外，原则上应先剖腹，术前置胸腔引流观察胸腔出血、漏气情况，改善呼吸。     

腹腔镜诊断治疗腹部刺伤90例报告

目的：探讨腹腔镜诊断及治疗腹部刀刺伤的价值。方法：腹部刀剌伤90例患者术前探查示与腹腔相通,应用腹腔镜完成诊断及治疗。结果：90例患者均在腹腔镜下明确诊断。17例无腹腔内脏损伤,52例于腹腔镜下完成治疗,21例中转开腹。结论：诊断明确的腹部刀刺伤选用腹腔镜探查,多可同时完成治疗,只少部分病例需开腹手术。     

腹部刀刺伤诊治探讨

目的　探讨腹部刀刺伤诊治策略 ,提高治疗水平。方法　回顾性总结分析 14 7例腹部刀刺伤的诊断和治疗。结果　剖腹手术 139例 ,伤口清创缝合 8例 ,治愈 14 5例 ,死亡 2例。结论　休克 ,大网膜及腹腔脏器外脱 ,腹痛伴腹膜炎体征 ,诊断性腹腔穿刺阳性均是手术指征。臀部刀刺伤要警惕损伤腹腔脏器。合并胸部伤或发生胸腹联合伤时 ,除有心脏大血管损伤外 ,原则上应先剖腹 ,术前置胸腔引流观察胸腔出血漏气情况 ,改善呼吸。     

腹部开放性损伤78例治疗体会

腹部开放性损伤多见、易诊断,但行剖腹探查及手术处理复杂。我院自1996年12月～2006年12月共收治腹部开放性损伤78例,现报告如下。临床资料1.一般资料:本组共78例,男性66例,女性12例;年龄17～37岁,平均25.6岁。致伤原因:铁片射伤24例,刀刺伤15例,钢筋刺伤39例。受伤至入院时间最短10min,最长半小时。本组采用非手术治疗19例,手术探查59例。其中,单纯腹壁穿透伤8例,合并腹内脏器损伤51例。腹内空腔脏器破裂25例,实质性脏器破裂12例,膈肌破裂7例,肠系膜损伤4例,十二指肠降部、胰腺、膀胱刺伤各1例。合并2个脏器以上损伤21例。2.治疗方法:本组…     

腹部锐器伤的诊断与治疗(附200例分析)

目的　提高腹部锐器伤的诊断和治疗水平。方法　总结分析我院普外科 1990年 1月至 1999年 6月所收治的 2 0 0例腹部锐器伤患者的资料。结果　男女比例 7∶1,小于 45岁者占 75 % ,就诊平均时间 3 .8小时 ,95 %为斗殴刀刺伤。单纯腹壁贯通伤占 2 0 % ,单个脏器损伤占 34% ,多个脏器损伤占 46 % ,休克发生率为 2 6 %。保守治疗 2 0例 ,均为单纯腹壁贯通伤 ,手术治疗 180例 ,总死亡率为 2 %。结论　腹部锐器伤的诊断虽然较为直观 ,但在 6种特殊情况下容易延误诊断 :①腹内脏器损伤后的延时表现 ;②经胸穿透膈肌导致腹内脏器损伤 ;③经剑突下方刺伤并穿透膈肌导致心脏损伤 ;④在受伤现场及来院途中的大量外出血导致休克 ;⑤腹膜后血肿的诊断 ;⑥直肠腹膜外损伤导致盆底腹膜贯通及腹内脏器损伤。在治疗方面 ,笔者强调了手术探查时的 6项要点 ,并对各类脏器损伤的处理要点提出建议。     

腹部刀刺伤的诊治体会

目的:总结腹部刀刺的诊治体会。方法:分析腹部刀刺伤3 6例的诊治临床资料。其中单纯腹壁损伤5例,单一脏器损伤18例,腹部多脏器损伤13例,合并膈肌、肺脏损伤4例。结果:本组病例全部手术治疗。治愈3 4例,死亡2例。结论:腹部刀刺伤为临床急诊,术前对伤情的判断主要依靠病史及查体,伤情重者要在抗休克的同时尽早手术,生命体征稳定而又考虑复合伤者应行CT和B超等检查,全身多处受伤者应优先处理危及生命的大出血。     

腹部穿透性锐器伤125例手术治疗体会

腹部穿透性锐器伤临床十分常见 ,尤其多见于腹部刀刺伤。我科近十年来共收治经手术探查的腹部穿透性锐器伤 12 5例 ,现就手术探查情况及体会报告如下。临床资料本组 12 5例 ,其中男 112例 ,女 13例 ,年龄 8～ 73岁 ,平均2 3 .4岁。 16～ 3 0岁之间 10 9例 ( 87.2 % )。刀刺伤 10 6例。12 5例病人均行剖腹探查手术 ,探查阴性 (不合并腹内脏器损伤 ) 2 6例 ( 2 0 .8% ) ,阳性 99例 ( 79.2 % )。其中合并实质性脏器损伤 3 0例 ( 2 4% ) ,合并空腔脏器损伤 46例 ( 3 6.8% )。而立位腹片提示膈下游离气体者 5 7例 ( 4 5 .6% )。肠系膜裂伤 11例 ,…     

腹腔镜诊治开放性腹部刀伤病例报告与分析

目的 总结腹腔镜诊治腹部开放性刀刺伤的经验.方法选择2007年3月至2011年3月,在本院收治并在腹腔镜下行腹腔探查及相应手术治疗的腹部开放性刀刺伤患者25例.5例单纯腹壁贯通伤行腹壁清创缝合术,4例小肠破裂及1例胃破裂患者在腹腔镜下行胃肠破裂修补术;另3例小肠破裂行选择性小切口开腹小肠部分切除术;4例大网膜及2例肠系膜破裂在腔镜下缝扎止血术;4例结肠破裂患者中转开腹2例行结肠造口、另2例行破裂口缝合＋近端肠管造口术.2例膀胱破裂请泌尿科1例行腔镜下修补、另1例行小切口开腹修补术.结果所有患者均经腹腔镜探查得到明确诊断及进一步治疗,平均手术时间（37.35±8.69）分钟,术后肛门排气时间平均（2.49±0.25）天,平均住院时间（4.87±0.98）天,均治愈出院,随访至今无并发症出现.结论腹腔镜诊治腹部开放性刀刺伤,具有创伤小、诊断率高、协助开腹手术方式选择、愈合快的优点,适合在腹部外伤急诊中推广应用.     

The role of CT scan in evaluation for laparotomy in patients with stab wounds of the abdomen

Not every patient with a penetrating stab wound of the abdomen requires laparotomy. This report evaluates use of computerized tomographic (CT) scan in assessment of stable asymptomatic patients, with penetrating abdominal stab wounds, as an indicator of the necessity of abdominal exploration. In a prospective study, 50 patients with abdominal stab wounds were treated successfully with observation only, after admission abdominal CT scan interpretation was negative for pathology in 45 patients. In the remaining five it was of such minor nature that conservative management was justified (Series I). Twenty-eight stable asymptomatic patients with penetrating stab wounds of the abdomen comparable to the ones in Series I had CT scan on admission, and then underwent exploratory laparotomy independent of their CT scan findings (Series II). Of these 28 patients, 22 had correct CT scan findings verified by laparotomy, three were false positive for intra-abdominal injury resulting in negative explorations, and three patients had such nonspecific findings as fluid or air in the abdomen incompatible with precise organ injury identification. Our study shows that CT scan in patients with abdominal stab wounds identifies solid organ injury with great specificity and sensitivity, evaluates the retroperitoneum well, and detects peritoneal penetration by demonstrating intraperitoneal fluid or air. CT scan was unreliable in detection of bowel injury and does not demonstrate diaphragmatic injuries.     

Non-operative management of abdominal stab wounds--an analysis of 186 patients

BACKGROUND: The modern management of abdominal stab wounds remains controversial and subject to continued reappraisal. In the present study we reviewed patients with abdominal stab wounds to examine and validate a policy of selective non-operative management with serial physical abdominal examination in a busy urban trauma centre with a high incidence of penetrating trauma. METHODS: Over a 12-month period (2005), the records of all patients with abdominal stab wounds were reviewed. Patients with abdominal stab wounds presenting with peritonitis, haemodynamic instability, organ evisceration and high spinal cord injury underwent emergency laparotomy. No local wound exploration, diagnostic peritoneal lavage or ultrasound was used. Haematuria in patients without an indication for emergency surgery was investigated with a contrasted computed tomography (CT) scan. Patients selected for non-operative management were admitted for serial clinical abdominal examination for 24 hours. Patients in whom abdominal findings were negative were given a test feed. If food was tolerated, they were discharged with an abdominal injury form. RESULTS: One hundred and eighty-six patients with abdominal stab wounds were admitted. There were 171 (91.9%) males, with a mean age of 29.5 years. Seventy-four patients (39.8%) underwent emergency laparotomy. There were 5 negative laparotomies (6.8%). The remaining 112 patients (60.2%) were assigned for abdominal observation. One hundred (89.3%) of these patients were successfully managed non-operatively. The remaining 12 patients underwent delayed laparotomy, which was negative in 2 cases (16.7%). Non-operative management was successful in 53.8% of patients overall. The overall sensitivity and specificity of serial abdominal examination was 87.3% and 93.5%, respectively. CONCLUSION: Serial physical examination alone for asymptomatic or mildly symptomatic patients with abdominal stab wounds enables a significant reduction in unnecessary laparotomies.     

Diagnostic and therapeutic laparoscopy for stab wounds of the anterior abdomen

BACKGROUND: At present, laparoscopy is used mainly as a diagnostic tool in patients with abdominal stab wounds. PATIENTS AND METHODS: Thirty-two hemodynamically stable patients with isolated stab wounds of the anterior abdomen, thought to be penetrating, were prospectively selected to undergo treatment via a laparoscopic approach. When possible, parenchymal wounds were coagulated or sealed, and wounds to the intestines were sutured or stapled. RESULTS: The results of laparoscopy were negative in 6 (18.8%) of the cases: nonpenetrating wounds in 4 cases and nonsignificant organ injury in 2 cases. A hemoperitoneum was identified in 13 (40.6%) of the cases, and significant organ injuries in 26 (81.3%) of the cases: stomach, 2; small bowel, 5; colon, 2; pancreas, 1; vascular injuries, 4; liver, 5; mesentery, 9. Laparoscopy was therapeutic in 20 (62.3%) of the cases. Conversion to open surgery was required in 6 (18.8%) of the cases. No injuries were missed, and no mortality occurred. Postoperative complications developed in 2 (6.2%) of the cases. The mean hospital stay was 4 days, with no late complications. CONCLUSIONS: Laparoscopy can avoid a number of unnecessary laparotomies and can treat most of the lesions found in hemodynamically stable patients with anterior abdominal stab wounds.     

Selective nonoperative management of penetrating abdominal solid organ injuries

OBJECTIVE: To assess the feasibility and safety of selective nonoperative management in penetrating abdominal solid organ injuries. BACKGROUND: Nonoperative management of blunt abdominal solid organ injuries has become the standard of care. However, routine surgical exploration remains the standard practice for all penetrating solid organ injuries. The present study examines the role of nonoperative management in selected patients with penetrating injuries to abdominal solid organs. PATIENTS AND METHODS: Prospective, protocol-driven study, which included all penetrating abdominal solid organ (liver, spleen, kidney) injuries admitted to a level I trauma center, over a 20-month period. Patients with hemodynamic instability, peritonitis, or an unevaluable abdomen underwent an immediate laparotomy. Patients who were hemodynamically stable and had no signs of peritonitis were selected for further CT scan evaluation. In the absence of CT scan findings suggestive of hollow viscus injury, the patients were observed with serial clinical examinations, hemoglobin levels, and white cell counts. Patients with left thoracoabdominal injuries underwent elective laparoscopy to rule out diaphragmatic injury. Outcome parameters included survival, complications, need for delayed laparotomy in observed patients, and length of hospital stay. RESULTS: During the study period, there were 152 patients with 185 penetrating solid organ injuries. Gunshot wounds accounted for 70.4% and stab wounds for 29.6% of injuries. Ninety-one patients (59.9%) met the criteria for immediate operation. The remaining 61 (40.1%) patients were selected for CT scan evaluation. Forty-three patients (28.3% of all patients) with 47 solid organ injuries who had no CT scan findings suspicious of hollow viscus injury were selected for clinical observation and additional laparoscopy in 2. Four patients with a "blush" on CT scan underwent angiographic embolization of the liver. Overall, 41 patients (27.0%), including 18 cases with grade III to V injuries, were successfully managed without a laparotomy and without any abdominal complication. Overall, 28.4% of all liver, 14.9% of kidney, and 3.5% of splenic injuries were successfully managed nonoperatively. Patients with isolated solid organ injuries treated nonoperatively had a significantly shorter hospital stay than patients treated operatively, even though the former group had more severe injuries. In 3 patients with failed nonoperative management and delayed laparotomy, there were no complications. CONCLUSIONS: In the appropriate environment, selective nonoperative management of penetrating abdominal solid organ injuries has a high success rate and a low complication rate.     

Abdominal wound injuries: diagnosis and treatment. Report of 79 cases

INTRODUCTION. - Traditionally, penetrating abdominal wounds justify routine laparotomy. However, this policy can be adapted to mechanism of injury (stab or firearm) and accuracy of imaging procedures if they eliminate visceral injury thus allowing close follow up. PATIENTS AND METHODS: Retrospective study of 79 patients (May 1995-May 2002) with a penetrating abdominal wound: (47 (59%) stab wounds and 32 (41 %) firearm wounds). Correlation between imaging and surgical findings, treatment, post-operative course were studied. RESULTS: Sixty-eight patients were operated on from the outset, and 11 underwent close follow-up. Of the 11 patients who had follow-up, (9 after stab wound and 2 after firearm wound), two had to be operated (1 in each group). Correlation between imaging and surgical findings was good in 34 (72%) patients after stab wound and in 21 (80%) after firearm wound; the mean number of visceral injuries was 1 and 3 respectively. Six patients (8%) died (mortality: 2% and 16% respectively), 12 (15%) had postoperative complications. CONCLUSION: Penetrating abdominal stab wounds can be treated by close follow-up if imaging excludes visceral injury. Firearm wounds still justify routine laparotomy due to both multiplicity of visceral injuries and bad prognosis.     

Prediction of injury caused by penetrating wounds to the abdomen, flank, and back

Controversy about the appropriate evaluation of penetrating abdominal, flank, and back injuries prompted this retrospective review of 311 patients at an urban level 1 trauma center over 5 years. Seventy-five (24%) patients sustained gunshot wounds to the abdomen. All patients with gunshot wounds underwent exploratory laparotomy; results of 67 laparotomies (89%) were positive. Of 236 patients sustaining stab wounds (140 abdominal wounds, 51 flank wounds, 26 back wounds, and 19 wounds to multiple sites), 147 were treated according to a selective protocol, based on results of physical examination, wound exploration, peritoneal lavage, and ancillary diagnostic studies. No injuries were found at celiotomy in three (2%) of these 147 patients. One false-negative result of evaluation of a flank wound occurred. Significant injuries were found in 13 patients (68%) with stab wounds to multiple sites, 61 patients (44%) with abdominal stab wounds, 15 patients (29%) with flank stab wounds, and four patients (15%) with back stab wounds. Mandatory exploration of gunshot wounds is justified. Physical findings of intra-abdominal injury or positive results of peritoneal lavage identify stab wound victims likely to benefit from surgical exploration. A policy of mandatory observation or routine celiotomy for treatment of stab wounds is not justified.     

Evisceration Following Abdominal Stab Wounds: Analysis of 66 Cases

Background  Abdominal stab wounds with evisceration remain an indication for emergency laparotomy. The purpose of this study was validate a policy of mandatory laparotomy for organ evisceration and a policy of selective nonoperative management with serial physical abdominal examination for omentum evisceration. Methods  The charts of 379 patients with abdominal stab wounds who presented to our Level I trauma center over a 3-year (January 2005 to December 2007) period were retrospectively reviewed. Altogether, 66 (17.4%) patients with evisceration were identified and included in the study. Indications for mandatory laparotomy were peritonitis, hemodynamic instability, organ evisceration, and a high spinal cord or severe head injury with an abdominal stab wound. Further data gathered included the organ eviscerated, intraabdominal organs injured, and complications. Injury severity was categorized using the revised trauma score (RTS), injury severity score (ISS), and penetrating abdominal index (PATI). Results  Organ and omentum evisceration occurred in 35 (53%) and 31 (47%) patients, respectively. Organs eviscerated were as follows (number of patients): small bowel in 27 (40.9%), stomach in 2 (3%), colon in 1 (1.5%), small bowel and stomach in 2 (3%), and small bowel and colon in 3 (4.5%). The mean RTS, ISS, and PATI scores were 7.71, 13.74, and 8.26, respectively. Only two (5.7%) patients with organ evisceration underwent a negative laparotomy. In total, 23 patients with omentum evisceration (21 with peritonitis, 1 with a head injury, 1 who failed abdominal observation) underwent therapeutic laparotomy. Six patients with omentum evisceration were managed successfully nonoperatively. Two patients with left thoracoabdominal omentum evisceration underwent delayed laparoscopy, which revealed a diaphragm injury in one patient. Overall, 57 (86.4%) patients with evisceration had an intraabdominal injury that required repair. Conclusions  Evisceration should continue to prompt operative intervention. An exception can be made to a select few patients with omentum evisceration with benign abdominal findings.     

Abdominal Stab Wounds in Children: an 18-Year Experience

Objective: Evaluation of the diagnosis, management, and the role of selective treatment in children with abdominal stab wounds. Patients and Methods: 59 children (56 male and three female) were included in the study. The patients' median age was 11.8 years (range, 5–14 years). Time between injury and admission was about 3 h. Laparotomy was performed in 44 patients (74%). Solid organ injury was detected in 32 of these patients (73%) and could not be observed in twelve (27%). 15 patients (26%) were treated conservatively, and only one (6.6%) underwent laparotomy during the follow-up. The stomach was the most frequently injured organ (ten patients), followed by the intestines (nine patients). Types of surgical treatment were as follows: primary suture in 28 patients, resection-anastomosis in three, and osteotomy in two. Results: Some prognostic factors such as presence of abdominal organ evisceration and pneumoperitoneum were not significantly correlated with intraabdominal organ injury, whereas some other risk factors such as acute abdomen on admission (p < 0.002) or abdominal clinical and hemodynamic findings (p < 0.001) showed significant correlation with intraabdominal organ injury. The relative risk (odds ratio) of developing an intraabdominal organ injury was > 2 for patients with signs of an acute abdomen on admission. Postoperative complications were observed in five patients with organ injuries. None of our patients died. Conclusions: Conservative treatment can be safely performed in most children with abdominal stab injuries. Signs of major internal hemorrhage or generalized peritonitis are an absolute indication for emergency operation for abdominal stab wounds. Peritoneal penetrations, free air on the abdominal X-ray, and omental or intestinal evisceration are poor indicators of significant organ injuries, and patients presenting these signs shold be closely followed up for developing acute abdominal symptoms. Received: November 2, 2001; revision accepted: February 15, 2002     

Diagnostic laparotomy for abdominal trauma. A university hospital experience

Following the experience of World War II, exploratory laparotomy in all patients with penetrating abdominal trauma was deemed mandatory until 1960 when Shaftan reported his experience with selective laparotomy. In 1973, Nance et al. reported on selective observation of abdominal stab wounds. There seems to be little controversy over mandatory laparotomy for abdominal gunshot wounds. Blunt trauma is generally managed expectantly with the adjunctive use of peritoneal lavage, CT scanning, and serial examinations of the abdomen. Despite the selective approach and the use of adjunctive diagnostic methods, exploratory laparotomy continues to be the most accurate method used to diagnose the presence of intra-abdominal injury. In order to examine our experience with diagnostic laparotomy for trauma, both blunt and penetrating, a retrospective study of 494 consecutive patients undergoing exploratory laparotomy over the past 4 years was undertaken. Abdominal stab wounds were explored under local anesthesia, and, if found to penetrate the posterior fascia, laparotomy was accomplished. All patients with abdominal gunshot wounds underwent exploration. Exploratory laparotomy in patients with blunt abdominal trauma was mandated by clinical signs, positive peritoneal lavage, or positive CT scan. All patients with unexplained shock and/or signs of peritoneal irritation underwent urgent laparotomy. In this series of 494 patients, 99 or 20 per cent of the entire group had a negative exploration (30% for stab wounds, 16% for gunshot wounds, and 19% for blunt abdominal trauma). The morbidity for the negative laparotomy group was limited to five patients with postoperative atelectasis. There were no anesthesia complications, iatrogenic intraoperative injuries, or wound infections. There were five deaths but none were laparotomy-related.(ABSTRACT TRUNCATED AT 250 WORDS)     

A prospective comparison of the selective observation and routine exploration methods for penetrating abdominal stab wounds with organ or omentum evisceration

BACKGROUND: Both routine laparotomy and selective observation methods have been used in the treatment of penetrating abdominal stab wounds with organ or omentum evisceration. There still are some conflicts about these treatment methods. METHODS: Between 1998 and 2003, 61 patients treated in the authors' emergency clinic because of penetrating abdominal stab wounds with organ or omentum evisceration were evaluated prospectively. Excepting those with absolute indications for mandatory laparotomy, these patients were treated by either routine laparotomy or selective observation methods. Their prognosis, rates of unnecessary laparotomy, length of hospital stay, and complications were compared using Fisher's exact test and Student's t test. RESULTS: Nine patients underwent mandatory laparotomy and were therefore excluded from the study. The overall incidence of the patients who had no significant abdominal pathology was 54.1% (33/61). The overall incidence of significant injuries among the asymptomatic patients was 36.5% (19/52). Routine laparotomy was performed for 21 patients, who experienced unnecessary laparotomy and complication rates of 33.33% and 19%, respectively. The mean length of hospital stay in this group was 137.38 +/- 53.25 hours. Of 31 patients, 24 who had been treated by selective observation methods were discharged without laparotomy. The unnecessary laparotomy and complication rates for this group were 6.45% (28.6% for the patients treated surgically) and 3.2%, respectively, whereas the mean length of hospital stay for this group was 81.22 +/- 42.46 hours. There were statistically significant differences in terms of unnecessary laparotomy rates and mean lengths of hospital stay, but no difference in terms of complication rates. CONCLUSION: The selective observation method is safe and superior to routine laparotomy for the treatment of penetrating abdominal stab wounds with omentum evisceration.