Stewart R J, Gupta R K, Purdie G L, Holloway L J, Isbister W H
Department of Surgery, Wellington School of Medicine, New Zealand.
Aust N Z J Surg. 1988 Dec;58(12):965-70. doi: 10.1111/j.1445-2197.1988.tb00102.x.
A randomized, controlled clinical trial, of sequential design, was undertaken to determine whether fine catheter aspiration cytology of the peritoneal cavity, using the percentage of neutrophils in the sample as the main test marker, reduces errors about urgent laparotomy in patients admitted to a surgical unit with acute abdominal pain. One hundred and forty-four patients with acute abdominal pain were studied. Of these, 26 were excluded because the test was unlikely to be useful and 20 did not consent. Conventional clinical assessment was undertaken and then the subjects were randomly allocated to have a peritoneal cytology test or not. After the test result was made available, the surgeon(s) decided whether to operate or continue conservative treatment. The correct decision was later ascertained by a blinded clinical referee. With the entry of the 98th patient the difference between the groups achieved the 5% significance level. The groups were well-matched in regard to demographic and other variables. The decision about urgent laparotomy was incorrect in only 8.2% of the test patients, compared with 28.6% of the others. It is concluded that fine catheter aspiration cytology of the peritoneal cavity is likely to reduce the numbers of unnecessary or delayed laparotomies when used in most patients admitted with acute abdominal pain.
采用序贯设计进行了一项随机对照临床试验，以确定使用样本中中性粒细胞百分比作为主要检测指标的腹腔细针穿刺细胞学检查，是否能减少外科病房收治的急性腹痛患者紧急剖腹手术的误诊情况。对144例急性腹痛患者进行了研究。其中，26例因该检查可能无用而被排除，20例不同意参与。进行了常规临床评估，然后将受试者随机分为接受或不接受腹腔细胞学检查两组。在获得检查结果后，外科医生决定是否进行手术或继续保守治疗。随后由一位不知情的临床裁判确定正确的决定。当第98例患者入组时，两组之间的差异达到了5%的显著性水平。两组在人口统计学和其他变量方面匹配良好。接受检查的患者中只有8.2%的紧急剖腹手术决定是错误的，而其他患者中这一比例为28.6%。结论是，对于大多数因急性腹痛入院的患者，腹腔细针穿刺细胞学检查可能会减少不必要或延迟的剖腹手术数量。
