Harth S, van den Broek R, Buylaert W, Derom F
Kliniek voor Algemene, Thoracale en Cardiovasculaire Heelkunde, Academisch Ziekenhuis, Gent.
Acta Chir Belg. 1987 Jul-Aug;87(4):265-8.
We discuss the way to diagnose intra-abdominal lesions caused by penetrating objects in the lower thorax. Let us call these wounds penetrating wounds. Two kinds of penetrating wounds are considered: 1. shotwounds; 2. knifewounds. 1. In shotwounds of the lower thorax there is not any non-surgical method available to find the associated intra-abdominal lesions. In these cases the results of: 1. physical examination; 2. local wound exploration; 3. echography of the abdomen and 4. peritoneal lavage cannot be trusted. Only laparotomy can show us if any associated lesion in the abdomen exists. 2. For knifewounds we can make almost the same remarks: 1. physical examination; 2. local exploration of the lesion; 3. echography of the abdomen are not to be considered as good diagnostic tools to find the associated intra-abdominal wounds. However in this situation the results of peritoneal lavage are to be trusted. Without omitting a 24 h observation of the patient the most rational criteria for a positive peritoneal lavage are red blood cell greater than 100.000/mm3; white blood cell greater than 500/mm3.
我们讨论诊断下胸部穿透性物体所致腹腔内损伤的方法。我们将这些伤口称为穿透伤。考虑两种穿透伤：1. 枪伤；2. 刀伤。1. 对于下胸部枪伤，没有任何非手术方法可用于发现相关的腹腔内损伤。在这些情况下，1. 体格检查；2. 局部伤口探查；3. 腹部超声检查和4. 腹腔灌洗的结果都不可靠。只有剖腹手术才能告知我们腹部是否存在相关损伤。2. 对于刀伤，我们可以给出几乎相同的看法：1. 体格检查；2. 损伤局部探查；3. 腹部超声检查不能被视为发现相关腹腔内伤口的良好诊断工具。然而，在这种情况下，腹腔灌洗的结果是可靠的。在不忽略对患者进行24小时观察的情况下，腹腔灌洗阳性的最合理标准是红细胞大于100,000/mm³；白细胞大于500/mm³。
