不同类型腹部刀刺伤的临床特点和预后

Clinical features and prognosis of different types of abdominal stab wound

目的比较不同类型腹部刀刺伤的临床特点和预后。方法收集2009年10月—2012年10月在摩洛哥赛达特哈桑二世医院收治的227例腹部刀刺伤患者的临床资料。根据膈肌有无损伤将患者分为胸腹联合伤组(53例)和单纯腹部损伤组(174例),再根据腹部刀口数量将单纯腹部损伤组分为腹部单处损伤亚组(126例)和腹部多处损伤亚组(含2处和2处以上损伤者,48例)。比较不同组别间的休克发生率、保守治愈率、阴性探查率、术后并发症发生率和病死率。结果胸腹联合伤组的休克发生率、术后并发症发生率和病死率分别为52.8%(28/53)、43.4%(23/53)和11.3%(6/53),均显著高于单纯腹部损伤组的23.6%(41/174)、28.7%(43/150)和2.3%(4/174,P值均<0.05)。腹部单处损伤亚组的保守治愈率为18.3%(23/126)、剖腹探查阴性率为16.5%(17/103),均显著高于腹部多处损伤组的2.1%(1/48)、0(P值均<0.05);腹部单处损伤亚组的休克发生率、术后并发症发生率和病死率分别为20.6%(26/126)、25.2%(26/103)和1.6%(2/126),与腹部多处损伤亚组的31.3%(15/48)、36.2%(17/47)和4.2%(2/48)比较,差异均无统计学意义(P值均>0.05)。结论胸腹联合伤患者病情危重,病死率较高,需要及时手术干预;腹部多处损伤者的保守治疗效果不佳,也需要及时行手术治疗。部分腹部开放性单发刀伤可在严密、动态监测下,通过保守治疗得以治愈。

Objective To compare the clinical features and prognosis of different types of abdominal stab wound. Methods Clinical data of 227 patients with different types of abdominal stab wound admitted to Hassan Ⅱ Hospital Settat Maroc from October 2009 to October 2012 were analyzed retrospectively. According to the diaphragma with injury or not, all patients were divided into thoracoabdominal combined injury group （53 cases） and abdominal injury group （174 cases）. The latter was divided into solitary abdominal injury group （126 cases） and multiple abdominal injury group （48 cases） according to the number of abdominal wound. Shock incidence, conservative cure rate, negative exploration rate, postoperative complications and mortality were compared between different groups. Results Compared with the abdominal injury group, shock incidence, postoperative complications, and mortality were significantly higher in the thoracoabdominal combined injury group （52.8 % [28/ 53] vs. 23.6% [41/174], 43.4% [23/53] vs. 28.7% [43/150], 11.3% [6/53] vs. 2.3% [4/174], all P〈 0.05）. The conservative cure rate and negative exploration rate in the solitary abdominal injury group were significantly higher than those in the multiple abdominal injury group （ 18.3 % [23/126] vs. 2. 1% [1/48], 16.5 % [17/103] vs. 0, both P〈0.05）. There were no significant differences in shock incidence （31.3% [15/48] vs. 20.6% [26/126]）, postoperative complications （36.2% [17/47] vs. 25.2% [26/103]） or mortality （4.2% [2/48] vs. 1.6% [2/126]） between multiple abdominal injury group and solitary abdominal injury group （all P〉O. 05）. Conclusion Thoracoabdominal combined injury is a special type of multiple trauma with severe injuries and high mortality; therefore, surgical treatment should be performed as quickly as possible. As conservative cure rate in multiple abdominal injury is very low, surgery should be done in early stage. Some patients with open solitary abdominal stab wound can be cured by conservative method under the strict, dynamic monitoring. （Shanghai Med J, 2014, 37： 614-617）