Sorkey A J, Farnell M B, Williams H J, Mucha P, Ilstrup D M
Department of Surgery, Mayo Clinic, Rochester, MN 55905.
Surgery. 1989 Oct;106(4):794-800; discussion 800-1.
To determine the roles of diagnostic peritoneal lavage (DPL) and abdominal computed tomography (CT) in the evaluation of blunt abdominal trauma, we compared our results in the eras before and after the advent of abdominal CT. In the pre-CT era 1977 to 1980 (group 1; 365 patients), DPL was the diagnostic procedure of choice. In the CT era 1983 to 1986 (group 2; 282 patients), DPL was used for unstable, polytraumatized patients, and CT was reserved for stable patients. The rate of delayed recognition of documented visceral injury (7%) was similar for groups 1 and 2. Celiotomy was nontherapeutic in 21 (14%) patients in group 1 and in 5 (5%) in group 2 (p less than 0.02). Despite immediate availability of abdominal CT, clinical examination alone or in combination with DPL was the diagnostic procedure of choice in 41% of those with blunt abdominal trauma in group 2. The complementary use of abdominal CT and DPL in those with blunt abdominal trauma decreased the rate of nontherapeutic celiotomy, did not result in a significant increase in missed injuries, and allowed identification of candidates for nonoperative management of solid organ injury.
为了确定诊断性腹腔灌洗（DPL）和腹部计算机断层扫描（CT）在钝性腹部创伤评估中的作用，我们比较了腹部CT出现前后两个时期的结果。在CT出现前的1977年至1980年（第1组；365例患者），DPL是首选的诊断方法。在CT时代的1983年至1986年（第2组；282例患者），DPL用于不稳定的多发伤患者，而CT则用于病情稳定的患者。第1组和第2组记录的内脏损伤延迟识别率（7%）相似。第1组有21例（14%）患者和第2组有5例（5%）患者的剖腹手术未起到治疗作用（p<0.02）。尽管腹部CT可随时进行检查，但在第2组钝性腹部创伤患者中，41%的患者单独进行临床检查或临床检查与DPL联合使用是首选的诊断方法。在钝性腹部创伤患者中，腹部CT和DPL的联合使用降低了非治疗性剖腹手术的发生率，没有导致漏诊率显著增加，并且能够识别出适合对实体器官损伤进行非手术治疗的患者。
