Author/Editor		Ivánecz, Árpád; Jagrič, Tomaž; Gajzer, Borut; Potrč, Stojan
Title		Vbodne rane trebuha - analiza 10-letne serije
Translated title		Abdominal stab wounds: a 10-year survey in Slovenia
Type		članek
Vol. and No.		Letnik 4, št. 1
Publication year		2011
Volume		str. 34-43
ISSN		1855-5640 - Acta medico-biotechnica : AMB
Language		eng
Abstract		Namen: Incidenca vbodnih ran trebuha (VRT) je na nekaterih območjih Sveta visoka. Dilema glede principov oskrbe takšnih poškodovancev je še vedno odprta. Namen naše študije je analiza epidemioloških in demografskih značilnosti takšnih poškodb, prikaz strategije zdravljenja ter primerjava rezultatov z rezultati iz literature. Metode: Opravili smo retrospektivno analizo vseh poškodovancev z VRT, ki so bili zdravljeni v naši ustanovi v obdobju od leta 1997 do 2007. Indikacija za laparotomijo je bilo stanje kardiocirkulatorne nestabilnosti ali znaki draženja peritoneja. Dokaz penetrantne poškodbe trebuha (PPT) je prav tako pomenila indikacijo za laparotomijo tudi pri bolnikih, ki so bili sicer brez simptomov. Rezultati: Skupaj je bilo v naši ustanovi obravnavanih 56 poškodovancev z VRT. 51 poškodovancev je bilo s samo eno vbodno rano, ki so bili ob sprejemu brez simptomov. Skupaj je bilo 23 laparotomij zaradi VRT, v povprečju dve na leto (letno število laparotomij je znašalo od 0 do 4). Od organov v trebušni votlini so bila največkrat poškodovana jetra in tanko črevo. Zapletov po operaciji je bilo 13% pri 23 bolnikih s PPT. Kasnih zapletov po odpustu iz bolnišnice je bilo 26%. Nihče od bolnikov z VRT ni umrl, bodisi zaradi vboda samega ali pa zaradi zapletov po operaciji. Zaključek: Število VRT v naši regiji je bistveno manjše kot v nekaterih drugih urbanih področjih po svetu. Prednost selektivno konzervativnega pristopa pri VRT je nesporna in se odraža v manjšem deležu nepotrebnih laparotomij. Takšen pristop pa zahteva izkušeno ekipo kirurgov, natančno oceno kliničnega stanja, neprekinjeno dostopnost do slikovnih preiskav in invazivno diagnostičnih postopkov ter možnost takojšnjega kirurškega ukrepanja. Kadar takšni pogoji niso dani, je bolj varen tradicionalen pristop - laparotomija ob dokazu PPT.Purpose: The incidence of abdominal stab wounds (ASWs) is high in some regions of the world. In general, the dilemma of the workup of these patients remains unsolved. We analyzed the epidemiological and demographical characteristics, and presented the strategy of the workup of patients with ASWs. Our results were compared with those from the literature. Methods: In this retrospective study we reviewed the records of all patients with ASWs treated between 1997 and 2007 at University Medical Center - Maribor (Maribor, Slovenia). In patients with circulatory instability and in those with signs of peritoneal irritation, explorative laparotomy was done immediately. The indication for laparotomy was also given in all asymptomatic patients with penetration across the peritoneum as evidenced by exploration of ASWs. Results: Fifty-six patients with ASWs were treated in our institution; 51 had a single stab wound and were asymptomatic on hospital admission. There were 23 explorative laparotomies for ASWs, the mean number being 2 per year (range, 0-4 per year). The liver and small intestine were the most often injured. Perioperative complications occurred in 13% of 23 stabbed patients. Late morbidity (after hospital discharge) was 26%. No patient from the present study died as a result of ASWs or perioperative complications. Conclusion: The incidence of ASWs in our part of the country is much lower than in many other urban regions in the world. The selective conservative approach to ASWs is advantageous and this is reflected in a lower number of unnecessary laparotomies. An experienced surgical team, continuous access to imaging systems and invasive procedures, and the possibility of immediate surgical intervention are necessary for this approach. If these conditions are not fulfilled, then the traditional approach- laparotomy - may be safer if there is evidence of a penetrating abdominal stab wound.
Keywords		vbodne rane trebuh laparotomija abdominal stab wounds laparotomy