诊断性腹腔镜检查在评估腹部前侧刺伤中的应用

The utility of diagnostic laparoscopy in the evaluation of anterior abdominal stab wounds.

作者信息

Kopelman Tammy R, O'Neill Patrick J, Macias Luis H, Cox Jordy C, Matthews Marc R, Drachman David A

机构信息

Division of Burns, Trauma Surgery and Surgical Critical Care, Department of Surgery, Maricopa Medical Center, Phoenix, AZ 85008, USA.

出版信息

Am J Surg. 2008 Dec;196(6):871-7; discussion 877. doi: 10.1016/j.amjsurg.2008.07.031.

DOI:10.1016/j.amjsurg.2008.07.031

PMID:19095102

Abstract

BACKGROUND

To assess if diagnostic laparoscopy (DL) is superior to nonoperative modes (serial abdominal examination with/without computed axial tomography [CAT] and diagnostic peritoneal lavage) in determining the need for therapeutic laparotomy (TL) after anterior abdominal stab wound (ASW).

METHODS

Retrospective review of ASW patients. Patients were divided into group A (DL/exploratory laparotomy) to identify peritoneal violation (PV) and group B (initial nonoperative modes).

RESULTS

Seventy-three patients met inclusion criteria. In group A (n = 38), 29 patients (76%) had PV by DL and underwent exploratory laparotomy. Only 10 (35%) underwent TL (sensitivity for PV = 100%; specificity and positive predictive value of PV in determining need for TL = 29% and 33%, respectively). In group B (n = 35), 7 patients (20%) underwent TL, yielding an improved specificity (96%) and positive predictive value (88%).

CONCLUSIONS

We find no role for DL in the evaluation of ASW patients solely to determine PV.

摘要

背景

评估诊断性腹腔镜检查（DL）在确定前腹部刺伤（ASW）后是否需要进行治疗性剖腹手术（TL）方面是否优于非手术模式（联合/不联合计算机断层扫描[CAT]的系列腹部检查以及诊断性腹腔灌洗）。

方法

对ASW患者进行回顾性研究。患者被分为A组（DL/探查性剖腹手术）以确定是否存在腹膜损伤（PV）和B组（初始非手术模式）。

结果

73例患者符合纳入标准。在A组（n = 38）中，29例患者（76%）通过DL发现存在PV并接受了探查性剖腹手术。只有10例（35%）接受了TL（PV的敏感性 = 100%；PV在确定是否需要TL方面的特异性和阳性预测值分别为29%和33%）。在B组（n = 35）中，7例患者（20%）接受了TL，特异性提高到96%，阳性预测值提高到88%。