|
文献考察：腹部刺創の手術適応は血圧不安定，持続する出血，汎発性腹膜炎の所見．peritoneal penetration（穿通性）だけでは手術適応はない．遊離ガスを認めた7例中消化管穿孔例は2例のみであった．
Br J Surg. 1999 Jan;86(1):76-80.
Indications for early mandatory laparotomy in abdominal stab wounds.
Leppaniemi AK, Voutilainen PE, Haapiainen RK.
BACKGROUND: Patients with an abdominal stab wound presenting with shock, peritonitis or evisceration are usually subjected to early laparotomy, although very few studies have been done to validate the criteria. METHODS: In a retrospective study of 209 consecutive patients with stab wounds of the anterior abdomen, flank or lower chest, 23 clinical and radiological criteria were evaluated for their accuracy in predicting the presence of significant abdominal organ injury. RESULTS: Overall, 89 patients (43 per cent) had a significant abdominal injury. The criteria with the highest positive predictive values for significant injury were: signs of continuing haemorrhage in initially normotensive patients (86 per cent), shock on admission (83 per cent) and generalized peritonitis (81 per cent). No positive direct or indirect signs of peritoneal penetration including omental evisceration, extraluminal air on plain radiography, or free peritoneal fluid on abdominal ultrasonography were independent predictors of significant injury. CONCLUSION: Signs of major internal haemorrhage or generalized peritonitis are reliable criteria by themselves for early laparotomy. Peritoneal penetration is a poor indicator of significant organ injury and warrants direct organ-specific evaluation, such as computed tomography or laparoscopy, to identify patients who can safely be treated without operation.PMID: 10027364
|
