Tan H L, Shankar K R, Ade-Ajayi N, Guelfand M, Kiely E M, Drake D P, De Bruyn R, McHugh K, Smith A J, Morris L, Gent R
Department of Paediatric Surgery and Paediatric Radiology, Women's and Children's Hospital and The University of Adelaide, Adelaide, South Australia.
J Pediatr Surg. 2003 May;38(5):714-6. doi: 10.1016/jpsu.2003.50190.
BACKGROUND/PURPOSE: Viscera stuck to the anterior abdominal wall from previous surgery risk injury during laparoscopic surgery. A prospective study was conducted to determine if these adhesions are detectable on ultrasound scan by showing a reduction in the normal visceral slide.
Patients undergoing laparoscopic procedure after a previous laparotomy underwent preoperative real-time ultrasound scan to observe if viscera slides freely under the abdominal wall. A reduction in slide was considered a positive sign of underlying adhesions. These findings were correlated with the operative findings.
Anterior abdominal wall scans were performed on 17 children. Reduced visceral slide was seen in 10. Viscero-parietal adhesions were found in 9 of 10 patients. Visceral slide was reduced in a very localized area in 6 patients, and, in these, a loop of bowel (n = 3), liver and bowel (n = 2), or liver (n = 1) was adherent. In 4, reduced visceral slide was seen over a wide area. Extensive adhesions were found in 3 of 4. One renal transplant patient with peritonitis had a false-positive ultrasound scan. At laparotomy there were no adhesions. The peritonitis is thought to have prevented an adequate examination. Seven patients had normal visceral slide. Of these, 4 had no adhesions, but 3 children had flimsy omental adhesions. The sensitivity and specificity of visceral slide in predicting adhesions were 75% and 80%, respectively.
Reduction in visceral slide is a good sign of underlying postoperative viscero-parietal adhesions. Ultrasonographic mapping of the abdominal wall may be useful in selecting an adhesion-free site for trocar insertion in children with previous operations requiring laparoscopic procedures.
背景/目的：既往手术导致的腹腔脏器与前腹壁粘连会增加腹腔镜手术时的损伤风险。本前瞻性研究旨在通过观察正常脏器滑动的减少情况，确定超声扫描能否检测出这些粘连。
曾接受剖腹手术的患者在接受腹腔镜手术前进行术前实时超声扫描，以观察脏器在腹壁下是否能自由滑动。滑动减少被视为存在潜在粘连的阳性体征。将这些结果与手术所见进行对比。
对17名儿童进行了前腹壁扫描。其中10名可见脏器滑动减少。10例中有9例发现脏层与壁层粘连。6例患者的脏器滑动减少局限于非常小的区域，其中3例为肠袢粘连，2例为肝与肠粘连，1例为肝脏粘连。4例患者的脏器滑动减少范围较广。4例中有3例发现广泛粘连。1例肾移植合并腹膜炎的患者超声扫描出现假阳性结果。剖腹手术时未发现粘连。推测腹膜炎影响了充分的检查。7例患者的脏器滑动正常。其中4例无粘连，但3例儿童有薄弱的网膜粘连。脏器滑动预测粘连的敏感性和特异性分别为75%和80%。
脏器滑动减少是术后存在脏层与壁层粘连的良好指征。对于既往有手术史且需要进行腹腔镜手术的儿童，腹壁超声检查有助于选择无粘连部位进行套管针穿刺。
