Drost T F, Rosemurgy A S, Kearney R E, Roberts P
Department of Surgery, University of South Florida, Tampa 33606.
Am Surg. 1991 Feb;57(2):126-8.
This study was undertaken to determine the appropriateness of celiotomy in 100 consecutive patients who underwent celiotomy solely because of positive diagnostic peritoneal lavage (DPL) following blunt (B) or stab (S) abdominal trauma. A total of 32 (32%) patients had positive DPL by laboratory criteria: blunt trauma: greater than 100K RBC/mm3, greater than 500 WBC/mm3; stab trauma: greater than 50K RBC/mm3, greater than 250 WBC/mm3. DPL in 68 patients was positive by gross inspection; 18 of these 68 patients' DPL laboratory results returned after surgery and did not satisfy the laboratory definition of positive DPL. In all 61 per cent underwent therapeutic celiotomy (TC) and 39 per cent underwent nontherapeutic celiotomy (NTC). Grade I and II spleen and/or liver injuries led to 79 per cent of NTCs. Positive DPL, determined by gross inspection or by laboratory testing, has a very poor accuracy rate when evaluated in light of evolving beliefs that promote nonoperative therapy for grade I and II liver and spleen injuries. When positive DPL is the sole indication for celiotomy in patients with blunt or stab abdominal trauma, an unacceptably large number of NTCs will be performed. DPL should have a limited role in the evaluation of patients with abdominal trauma.
本研究旨在确定连续100例因钝性（B）或锐器（S）腹部创伤后诊断性腹腔灌洗（DPL）阳性而单纯接受剖腹手术患者剖腹手术的适宜性。共有32例（32%）患者根据实验室标准DPL呈阳性：钝性创伤：红细胞计数大于100K/mm³，白细胞计数大于500/mm³；锐器创伤：红细胞计数大于50K/mm³，白细胞计数大于250/mm³。68例患者的DPL经肉眼检查呈阳性；这68例患者中有18例的DPL实验室结果在术后返回，不符合DPL阳性的实验室定义。在所有患者中，61%接受了治疗性剖腹手术（TC），39%接受了非治疗性剖腹手术（NTC）。I级和II级脾和/或肝损伤导致了79%的NTC。根据目前提倡对I级和II级肝脾损伤进行非手术治疗的观念来评估时，通过肉眼检查或实验室检测确定的DPL阳性准确率非常低。当DPL阳性是钝性或锐器腹部创伤患者剖腹手术的唯一指征时，将会进行数量多得不可接受的NTC。DPL在腹部创伤患者的评估中应发挥有限的作用。
