Clinical Study Of Laparoscopy In The Treatment Of Abdominal Trauma

Part Ⅰ: Retrospective case-matched study of laparoscopy and laparotomy in the treatment of abdominal traumaPurposeAbdominal trauma is common in peacetime and wartime.In the past,laparotomy was the most important method for the treatment of abdominal trauma.Laparoscopic technology has made great progress in the 20 th century.Compared with traditional open surgery,laparoscopic surgery has less pain,shortens the length of stay of patients,and reduces the incidence of postoperative complications.At present,there is a lack of randomized controlled trials to explore the value of laparoscopy in the treatment of abdominal trauma,and the number of cases included in the existing research is generally small,the existing evidence is not enough to form a generally recognized expert consensus.Therefore,we carried out this study,hoping to provide more strong evidence for laparoscopic treatment of abdominal trauma.MethodsThe clinical data of patients with abdominal trauma treated in our emergency trauma center in recent 9 years were analyzed retrospectively.The 1:1 PSM method was used to select the most suitable open control case for laparoscopic cases.The matched cases were taken as the object of study and were included in the laparotomy group and the endoscopy group according to the mode of operation.The differences of heart rate and blood pressure,pre-hospital time,preoperative time,operation time,intraoperative blood loss,postoperative ICU time,postoperative ventilator time,postoperative first anal exhaust time,postoperative drainage time,total hospital stay,total hospitalization cost,incidence of complications and unplanned secondary operation rate were analyzed and compared between the two groups.ResultsThe most common cause of abdominal trauma was traffic accident injury,the most common organ involved was the small intestine,the total hospital stay in the laparoscopy group was significantly shorter than that in the laparotomy group(p=0.000),and the intraoperative blood loss in the laparotomy group was significantly less than that in the laparotomy group(p=0.000).Among the open injuries,the first anal exhaust time in the laparoscopic group was shorter than that in the open group(P=0.004).In the closed injury subgroup,the average operation time in the laparoscopic group was longer than that in the open group(p=0.030).The total hospitalization cost of laparoscopic patients in the severe injury and severe injury subgroup was higher than that in the open group(P=0.004).ConclusionBy reviewing the data of abdominal trauma cases treated in the Emergency Trauma Center of our hospital in the past 9 years,using PSM pairing method to reduce the interference of confounding factors,we draw the following conclusions: laparoscopic surgery has less bleeding and less total hospital stay than open surgery,and the recovery time of intestinal function after laparoscopic surgery is faster than that of laparoscopic surgery.For patients without chest trauma,abdominal surgery can reduce the use of postoperative ventilator.For penetrating abdominal trauma,laparoscopic surgery will not prolong the operation time,while for blunt abdominal trauma,laparoscopic surgery will prolong the operation time.Part Ⅱ: Meta analysis of NOM and OM in the treatment of traumatic splenic rupture in adultsPurposeBy reviewing and comparing the previous studies of NOM and OM in the treatment of adult traumatic splenic rupture,to find the basis for the selection of patients to formulate the treatment strategy of NOM,in order to guide our clinical practice.MethodsA total of 10116 subjects were included in 17 studies,with an overall f NOM% of 7.2%.In patients with spleen AAST grade I-II,the proportion of patients who received NOM treatment was higher than that of patients with OM;for IV-V grade,the proportion of patients who received OM treatment was higher than that of NOM;in patients with spleen injury of III grade,there was no significant difference between the two groups.Compared with OM,patients with splenic injury treated with NOM had lower mortality,shorter postoperativeICU time and shorter hospital stay.Results17 studies were included,with a total of 10116 subjects,with an overall f NOM% of 7.2%.In patients with spleen AAST grade I-II,the proportion of patients who received NOM treatment was higher than that of patients with OM;IV-V grade,the proportion of patients who received OM treatment was higher than that of patients with spleen injury of NOM;III,and there was no significant difference between the two groups.Compared with OM,splenic injury treated with NOM has lower mortality,shorter postoperative ICU time and shorter hospital stay.ConclusionNOM is a safe and effective treatment for patients with traumatic splenic injury according to AAST grade I-II.Compared with traditional OM,NOM can shorten ICU time and hospitalization time and reduce perioperative mortality in patients with traumatic splenic rupture,but most of the current studies are based on clinicians’ choice of patients with different grades of splenic injury.We need more research to confirm this difference.