槍傷引起的生殖泌尿道創傷有較高比率合併其他外傷
作者：Jill Stein
出處：WebMD醫學新聞
June 1, 2010 (加州舊金山) — 根據發表於美國泌尿道協會2010年科學會議的資料，多數遭受生殖泌尿道槍傷(gunshot wound，GSW)的民眾發生至少一種的非生殖泌尿器官損傷。
主要研究者、密西根大學泌尿科助理教授Jerilyn M. Latini醫師向Medscape Urology表示，我們的研究意味著開業泌尿科醫師應對所有生殖泌尿系統槍傷病患的合併外傷保持高度警覺。
她表示，生殖泌尿創傷的處置，依據病患狀態與相關外傷的嚴重度，必須對其他器官也進行外科檢查，例如，主要中空臟器或者血管損傷，必須緊急檢視且和相關生殖泌尿創傷協同處置。
Latini醫師等人回顧了一個第1級創傷中心資料庫，檢視最近12年內所有因為GSW而有任何創傷的病患資料，他們檢視了2941名GSW創傷民眾，平均年紀30歲，多數是男性，平均損傷嚴重度分數(ISS)是22.2 ± 15.4分(範圍為1- 75)，生殖泌尿GSW發生率在研究期間內呈現上升。
Latini醫師報告指出，美國年輕男性的主要死因中，槍傷僅次於汽機車碰撞之後，因為喪失生殖力的直接和間接醫療花費，是相當大的健康與經濟負擔。
她指出，美國、非洲與某些歐洲國家，平民的槍傷發生率增加。
她表示，迄今，多數有關生殖泌尿系統GSW的文獻報告來自戰時/軍事戰鬥。
在本篇研究中，年紀、性別、種族、ISS、生殖泌尿損傷位置、任何器官的相關損傷、處置、結果等資料，都是來自位於底特律Henry Ford Health System的創傷資料庫，以及醫療記錄和驗屍報告。
所有病患都以標準創傷規範評估和處置。
在2941名病患中，309人(10.5%)持續有生殖泌尿道創傷、併有或未併有相關外傷。
最常見的生殖泌尿道GSW創傷包括腎臟(55%)、陰囊(21%)、膀胱(19%)、睪丸(12%)以及陰莖(8%)；有些創傷包括1個以上的生殖泌尿器官。
整體而言，309名生殖泌尿創傷病患中有284人(92%)發生至少1種的非生殖泌尿器官系統損傷。非生殖泌尿器官GSW損傷包括，腹部器官68%、胸部器官39%、骨科/下肢31%、骨科上肢23%、血管系統15% (主動脈和/或腔靜脈者佔11%)、頭/頸部15%、脊索13%。
根據影響的器官，非生殖泌尿器官GSW損傷的嚴重度各異。例如，當GSW的位置在腎臟時，肝臟是最常被牽連的器官，如果是小腸槍傷時，輸尿管最常被牽連。
多數生殖泌尿GSW是以手術處置，每個病患平均接受2.2 ± 2.0次手術。
整體而言，死亡的有84名病患(27%)，死因通常和非生殖泌尿器官損傷有關，50名病患(16%)在到院時死亡。
Latini醫師強調，需要對發生GSW的民眾進行跨科別的綜合評估與處置。她解釋，藉由跨科別合作，我們將有一個協同方式、由各次專科領域的外科醫師來處置多處創傷病患。
Latini醫師宣告沒有相關財務關係。
美國泌尿科協會(AUA)2010年科學會議：摘要1230。發表於2010年5月31日。
Genitourinary Trauma Due to Gunshot Wounds Produces High Rate of Associated Injuries
By Jill Stein
Medscape Medical News
June 1, 2010 (San Francisco, California) — Most civilians who sustain a gunshot wound (GSW) to the genitourinary tract develop at least 1 nongenitourinary organ system injury, according to data released at the American Urological Association 2010 Annual Scientific Meeting.
"Our results mean that the practicing urologist must maintain a high degree of suspicion about associated injuries in all patients who sustain a gunshot wound to the genitourinary system," principal investigator Jerilyn M. Latini, MD, assistant professor of urology at the University of Michigan in Ann Arbor, told Medscape Urology.
"The management of genitourinary injuries must be staged with surgical exploration of other organs, depending on patient status and the severity of associated injuries," she said. "For example, major hollow viscus or vascular injuries must be addressed emergently with coordinated management of the associated genitourinary injuries."
Dr. Latini and colleagues reviewed a level?1 trauma center registry to identify all patients who sustained any trauma as a result of a GSW over a recent 12-year period. They identified 2941 civilian patients with GSWs. Patients were 30 years old, on average, and most were men. The mean Injury Severity Score (ISS) was 22.2?± 15.4 (range, 1?- 75). The incidence of genitourinary GSWs increased over the study period.
"After motor vehicle collisions, gunshot wounds are the leading cause of death among young males in the United States. Dr. Latini reported, adding that "the direct medical costs and indirect costs due to loss of productivity represent a significant health and economic burden."
"The incidence of civilian gunshot wounds is increasing in the United States, Africa, and some European countries," she added.
To date, most of the literature on GSWs to the genitourinary system has involved reports from wartime/military combat, she said.
In this study, sex, age, race, ISS, genitourinary injury location, associated injuries involving any organ system, management, and outcomes were obtained from the trauma registry at the Henry Ford Health System in Detroit, Michigan, along with medical records and autopsy reports.
All patients were evaluated and managed with standard trauma protocols.
Of the 2941 patients, 309 (10.5%) sustained genitourinary trauma with or without associated injuries.
The most common genitourinary GSW injuries involved the kidneys (55%), scrotum (21%), bladder (19%), testis (12%), and penis (8%); some involved more than 1 genitourinary organ.
Overall, 284 of the 309 patients with genitourinary trauma (92%) experienced at least 1 nongenitourinary organ system injury. Nongenitourinary GSW injuries involved the abdominal organs in 68% of patients, the chest in 39%, orthopedic/lower extremities in 31%, orthopedic upper extremities in 23%, the vascular system in 15% (with aorta and/or vena cava involvement in 11%), head/neck in 15%, and the spinal cord in 13%.
The severity of nongenitourinary GSW injuries varied, depending on the organ affected. For example, the liver was most commonly involved when the kidney was the site of the GSW, and the ureter was most often involved when there was a small bowel injury.
Most genitourinary GSWs were managed surgically, with a mean of 2.2 ± 2.0 surgeries per patient.
Overall, 84 patients (27%) died. The cause of death was usually associated nongenitourinary injuries. Fifty patients (16%) were dead on arrival at the hospital.
Dr. Latini emphasized that a comprehensive multidisciplinary approach to the evaluation and management of civilian GSW patients is required. "By multidisciplinary, I am referring to a coordinated approach to managing multitrauma patients among the trauma surgeons in all subspecialty areas," she explained.
Dr. Latini has disclosed no relevant financial relationships.
American Urological Association (AUA) 2010 Annual Scientific Meeting: Abstract?1230. Presented on May?31, 2010.
