腹部枪伤选择性非手术管理策略研究现状

Current status regarding selective non-operative management of abdominal gunshot wounds

腹部枪伤后一般常规行剖腹探查术。有研究显示,20%~30%的腹部枪伤剖腹探查术是非治疗性或阴性的,且剖腹探查术后可并发局部感染等;选择性非手术管理(SNOM)策略可减少手术并发症、缩短住院时间、降低住院费用,已被广泛推荐用于腹部钝器伤及刺伤患者。然而,SNOM策略是否适用于腹部枪伤患者,以及适用于哪些腹部枪伤患者尚不明确。该文就腹部枪伤采取SNOM策略的问卷调查、临床实践及大宗系统评价等研究结果进行综述,并归纳如何筛选更适合非手术管理的腹部枪伤患者,以期指导临床实践。

Laparotomy should be routinely performed in the cases of abdominal gunshot wounds.However,recent studies found that 20%-30%abdominal gunshot wounds were non therapeutic or negective,and some complications secondary to laparotomy,such as local infection,often developed.Selective non-operative management(SNOM)can reduce the incidence of operative complications,length of hospitalization,and medical cost,thus has been recommended for the patients with abdominal blunt and stabbing wounds.However,it remains obscure whether SNOM is suitable for patients with abdominal gunshot wounds and which patients should be suitable for SNOM.This paper aims to review the important findings from questionnaire survey,clinical practice studies,and large-scale systematic reviews,and then propose how to identify the candidates for SNOM,hoping to be helpful for improving our management strategy of abdominal gunshot wounds.