A Unified Approach To The Treatment Of Patients With Penetrating Stab Wounds To The Abdomen
DOI:
https://doi.org/10.11603/2414-4533.2017.1.7066Keywords:
selective non-operative management, stab wounds, abdominal cavity, laparoscopy.Abstract
During the period from 2010 to 2015, according to the Ministry of health of Ukraine, the total mortality rate in Ukraine is at the level of 14.5–16.3 %. In 6 % of all deaths the cause was trauma. Open penetrating abdominal trauma remains one of the major causes of deaths. While stab wounds are found almost three times more often than gunshot [3]. In recent years, the world has redefined approaches to the management of patients with penetrating wounds, leaning in the direction of selective use of operative and non-operative methods of treatment [2].
Widespread is a method of selective non-operative management of patients with penetrating wounds of the abdomen [4,10,14]. The essence of this method is that by applying modern diagnostic methods, and clinical monitoring of the patient, in certain cases it is possible to dispense with the use of laparotomy. This technique allows in 55 % of cases, stab wounds manage cases without resorting to surgical intervention, to reduce the number of unnecessary laparotomies to 9–19 %, reduce the duration of patients' stay in hospital was 3.9 days compared to 6, with laparotomy, as well as to reduce material costs for treatment of patients.
Selection of patients for non-operative management to better focus on the data of common clinical examination (overall sensitivity and specificity of serial clinical examination of the abdomen is 87.3 and 93.5 % per cent respectively) [10]. A good help are the data of computer tomography, however, the sensitivity and specificity of this method ranges from different authors from 60 % to over 90 % [4,9,11,13]. The diagnostic value of ultrasound examination in the first hours after the injury is just 46 % [12], and review x-rays to 2.6 % [7]. The use of laparoscopy in the diagnosis and treatment of stab wounds of the abdominal wall is a priority method in the case of stable hemodynamic patients [8].
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