Bailey R L, Laws H L
Department of Surgery, Carraway Methodist Medical Center, Birmingham, Ala. 35234.
South Med J. 1990 Apr;83(4):422-4. doi: 10.1097/00007611-199004000-00015.
Diagnostic peritoneal lavage (DPL) is an established procedure in evaluation of trauma victims but is less well established for use in patients suspected of having acute intra-abdominal disease. Twenty-six seriously ill patients at our institution who had DPL for acute intra-abdominal disease form the basis of this report. Use of DPL indicated sepsis in ten patients; in seven of the ten, findings were confirmed at celiotomy or autopsy. Only one of the ten survived without laparotomy or confirmatory necropsy indicating the result of DPL had been false-positive. Sepsis was not indicated by DPL in 16 patients. Fourteen patients appeared to have true-negative results confirmed by operation (three patients), autopsy (four patients), or survival longer than two weeks (seven patients). Complications occurred in one patient whose DPL showed sepsis. Two patients with negative results of DPL died within two weeks of examination without confirmatory operation or autopsy and could not be evaluated. We therefore, consider the overall diagnostic accuracy in our patient group to be 95%. We recommend the use of DPL in patients suspected of an acute intra-abdominal disease process who are unable to undergo other evaluation for reasons such as critical illness.
诊断性腹腔灌洗（DPL）是评估创伤患者的既定程序，但在疑似患有急性腹腔内疾病的患者中应用较少。本报告基于我院26例因急性腹腔内疾病接受DPL的重症患者。DPL显示10例患者存在脓毒症；其中7例在剖腹手术或尸检时得到证实。10例患者中只有1例未经剖腹手术或尸检证实存活，提示DPL结果为假阳性。16例患者DPL未提示脓毒症。14例患者经手术（3例）、尸检（4例）或存活超过两周（7例）证实为真阴性结果。1例DPL显示脓毒症的患者出现了并发症。2例DPL结果为阴性的患者在检查后两周内未进行确诊手术或尸检死亡，无法评估。因此，我们认为我们患者组的总体诊断准确率为95%。我们建议对因重症等原因无法接受其他评估的疑似急性腹腔内疾病患者使用DPL。
