Villavicencio R T, Aucar J A
Department of Surgery, University of Pittsburgh, PA 15261, USA.
J Am Coll Surg. 1999 Jul;189(1):11-20. doi: 10.1016/s1072-7515(99)00052-6.
The optimum roles for laparoscopy in trauma have yet to be established. To date, reviews of laparoscopy in trauma have been primarily descriptive rather than analytic. This article analyzes the results of laparoscopy in trauma.
Outcome analysis was done by reviewing 37 studies with more than 1,900 trauma patients, and laparoscopy was analyzed as a screening, diagnostic, or therapeutic tool. Laparoscopy was regarded as a screening tool if it was used to detect or exclude a positive finding (eg, hemoperitoneum, organ injury, gastrointestinal spillage, peritoneal penetration) that required operative exploration or repair. Laparoscopy was regarded as a diagnostic tool when it was used to identify all injuries, rather than as a screening tool to identify the first indication for a laparotomy. It was regarded as a diagnostic tool only in studies that mandated a laparotomy (gold standard) after laparoscopy to confirm the diagnostic accuracy of laparoscopic findings. Costs and charges for using laparoscopy in trauma were analyzed when feasible.
As a screening tool, laparoscopy missed 1% of injuries and helped prevent 63% of patients from having a trauma laparotomy. When used as a diagnostic tool, laparoscopy had a 41% to 77% missed injury rate per patient. Overall, laparoscopy carried a 1% procedure-related complication rate. Cost-effectiveness has not been uniformly proved in studies comparing laparoscopy and laparotomy.
Laparoscopy has been applied safely and effectively as a screening tool in stable patients with acute trauma. Because of the large number of missed injuries when used as a diagnostic tool, its value in this context is limited. Laparoscopy has been reported infrequently as a therapeutic tool in selected patients, and its use in this context requires further study.
腹腔镜检查在创伤治疗中的最佳作用尚未确定。迄今为止，关于创伤腹腔镜检查的综述主要是描述性的，而非分析性的。本文分析了创伤腹腔镜检查的结果。
通过回顾37项研究（涉及1900多名创伤患者）进行结果分析，并将腹腔镜检查作为一种筛查、诊断或治疗工具进行分析。如果腹腔镜检查用于检测或排除需要手术探查或修复的阳性发现（如腹腔积血、器官损伤、胃肠道溢出、腹膜穿透），则被视为筛查工具。当腹腔镜检查用于识别所有损伤，而不是作为识别剖腹手术首要指征的筛查工具时，被视为诊断工具。仅在那些腹腔镜检查后必须进行剖腹手术（金标准）以确认腹腔镜检查结果诊断准确性的研究中，它才被视为诊断工具。在可行的情况下，分析了创伤中使用腹腔镜检查的成本和费用。
作为一种筛查工具，腹腔镜检查漏诊了1%的损伤，并帮助63%的患者避免了创伤性剖腹手术。作为诊断工具使用时，腹腔镜检查每位患者的漏诊率为41%至77%。总体而言，腹腔镜检查的手术相关并发症发生率为1%。在比较腹腔镜检查和剖腹手术的研究中，成本效益尚未得到一致证明。
腹腔镜检查已作为一种筛查工具安全有效地应用于急性创伤稳定患者。由于作为诊断工具使用时漏诊损伤数量较多，其在这种情况下的价值有限。腹腔镜检查作为一种治疗工具在特定患者中的报道较少，其在这种情况下的应用需要进一步研究。
