Indications of Selective Abdominal Exploration in Patients with Abdominal Stab Wounds - ข้อบ่งชี้เพื่อคัดเลือกผู้ป่วยผ่าตัดเปิดช่องท้องในผู้ป่วยแผลถูกแทงทะลุช่องท้อง

Abstract

          The objective of this analytical retrospective study covered all indications and factors that affected decisions to perform surgery on patients admitted at Phrae hospital with abdominal stab wounds during a four-year period from January 2001 to December 2004. The study involved 159 patients, 90.6 percent of whom were male, with the average age of 33.29 years. It was found that only 125 cases (78.6 percent) required operation. The data were analyzed by chi-square test.

            The results showed that clinical factors of overt peritonitis bleeding of GI tract, and bleeding of urinary tract all required laparotomy and all of these patients (100 percent) reportedly had had significant organ injuries. Type of injury and the clinical factors that needed immediate exploration in the groups of shock, analyzed by chi-square test, revealed significant differences between the necessary and unnecessary laparotomy groups (p<0.01). Whereas in the organ evisceration and generalized tender of abdomen groups significant organ injuries had been detected in only 75.6 and 73.3 percent of them respectively, and failed to underline urgent requirement for the operation (p>0.05). While wound exploration group showed statistically significant difference (p<0.05). However, in forty-five cases of wound exploration group there were twenty-three patients actually required surgery; its positive predictive value was 52.27 percent when analyzed by screening test. Moreover, its specificity was only 38.24 percent that shows low accuracy prediction for laparotomy. In the group of many clinical indications or factors had less un-necessary laparotomy, there had been no mortality or severe complications. in the unnecessary laparotomy group.

            This study supports the use of clinical indications as a predictor of abdominal stab wounds laparotomy. When there are clear sign of overt peritoneal sign, shock and internal bleeding, its may be concluded as absolute emergency indications that patients required immediate surgery. Other clinical indications, surgery can be delayed and its should be classified as the selective indications for laparotomy, thereby reducing the number of unnecessary surgery. But in the provincial areas where there are always shortage of surgeons selective method may be performed only in particular high risk cases for the patient's safety.