Alverdy J C, Saunders J, Chamberlin W H, Moss G S
Department of Surgery, Michael Reese Hospital and Medical Center, Chicago, Illinois 60616.
Am Surg. 1988 Jul;54(7):456-9.
Despite the advent of sophisticated diagnostic technology the diagnosis of the surgical abdomen in the Intensive Care Unit continues to pose a problem for the surgeon. A retrospective analysis was carried out to evaluate the utility of diagnostic peritoneal lavage to diagnose intra-abdominal surgical disease. Diagnostic peritoneal lavage was carried out in patients in whom the physical exam was deemed unreliable, such as in patients with cardiopulmonary instability or mental obtundation. Patients were included in the study if autopsy or laparotomy confirmation of the lavage data was available. Forty four patients met the inclusion criteria and formed the basis of this study. Of the twenty three patients with a positive lavage, three false-positive diagnostic peritoneal lavages were discovered, either at laparotomy or postmortem exam. Of the twenty one patients where diagnostic peritoneal lavage was negative, no false-negatives were discovered at autopsy or laparatomy. Therefore, this test is 100 per cent sensitive and 88 per cent specific. It is concluded that a negative diagnostic peritoneal lavage makes intra-abdominal surgical disease highly unlikely. However, a positive lavage may require further diagnostic work-up.
尽管先进的诊断技术不断涌现，但重症监护病房中外科急腹症的诊断对外科医生来说仍然是个难题。我们进行了一项回顾性分析，以评估诊断性腹腔灌洗在诊断腹腔内外科疾病方面的效用。对于那些体格检查结果不可靠的患者，如存在心肺功能不稳定或意识障碍的患者，进行了诊断性腹腔灌洗。如果尸检或剖腹手术能够证实灌洗数据，则将患者纳入研究。44名患者符合纳入标准并构成了本研究的基础。在23例灌洗结果为阳性的患者中，在剖腹手术或尸检时发现了3例假阳性诊断性腹腔灌洗。在21例诊断性腹腔灌洗结果为阴性的患者中，在尸检或剖腹手术时未发现假阴性结果。因此，该检查的敏感性为100%，特异性为88%。结论是，诊断性腹腔灌洗结果为阴性时，腹腔内外科疾病的可能性极小。然而，灌洗结果为阳性可能需要进一步的诊断检查。
