Walters H L, Hupp J, McCabe C J, Burke J F
Trauma Service, Massachusetts General Hospital, Boston 02114.
Surg Gynecol Obstet. 1987 Dec;165(6):496-502.
Peritoneal lavages performed in 161 patients who had sustained blunt (93 per cent) and penetrating (7 per cent) trauma were prospectively studied in order to assess our indications and technique, as well as to document the accuracy and complication rate in the hands of an Advanced Trauma Life Support trained resident staff. The most common indication for the performance of a lavage was blunt trauma to the abdomen associated with an altered mental status due to injury to the head or substance abuse. The semiopen technique was used 91.0 per cent of the time with a complication rate of 0.6 per cent. The open technique was used 9 per cent of the time on patients who had undergone previous limited abdominal operations, those who were pregnant, those with dilated intestine and for those patients with evidence of portal hypertension. Aspiration of greater than 10 milliliters of gross blood, an erythrocyte count greater than 100,000 per millimeter to the third power, or a white blood cell count greater than 500 per millimeter to the third power or an elevated amylase or bilirubin level in the lavage effluent, were the criteria used for a positive result in blunt trauma. The accuracy rate was 93 per cent with eight false-positive and three false-negative examinations. The sensitivity rate was 94 per cent and the specificity rate was 93 per cent. While most reported series classify lavage results as true-positive when intraperitoneal blood is found at exploration, even if secondary to trivial injuries which do not require surgical therapy (nontherapeutic laparotomy), we believe that these should be classified as false-positive results, as was done in this study. Computerized tomographic scanning may be more useful than peritoneal lavage in the evaluation of patients with pelvic fractures or other retroperitoneal injuries which often result in false-positive lavage. Peritoneal lavage is often an inaccurate indicator of isolated intestine and diaphragmatic or retroperitoneal injury. Given its simplicity, low complication rate and accuracy, peritoneal lavage can be safely performed by surgeons in training to evaluate the victim of trauma.
对161例钝性伤（93%）和穿透伤（7%）患者进行了前瞻性腹膜灌洗研究，以评估我们的适应证和技术，并记录经过高级创伤生命支持培训的住院医师团队操作时的准确性和并发症发生率。进行灌洗最常见的适应证是腹部钝性伤合并因头部受伤或药物滥用导致的精神状态改变。91.0%的时间采用半开放式技术，并发症发生率为0.6%。开放式技术用于9%曾接受过有限腹部手术的患者、孕妇、肠扩张患者以及有门静脉高压证据的患者。吸出超过10毫升肉眼可见的血液、红细胞计数大于每立方毫米100,000个、白细胞计数大于每立方毫米500个或灌洗流出液中淀粉酶或胆红素水平升高，是钝性伤阳性结果的判断标准。准确率为93%，有8例假阳性和3例假阴性检查。敏感度为94%，特异度为93%。虽然大多数报道系列在探查时发现腹腔内有血时将灌洗结果分类为真阳性，即使是继发于不需要手术治疗的轻微损伤（非治疗性剖腹术），但我们认为这些应分类为假阳性结果，本研究就是这样做的。在评估骨盆骨折或其他常导致灌洗假阳性的腹膜后损伤患者时，计算机断层扫描可能比腹膜灌洗更有用。腹膜灌洗往往是孤立肠损伤、膈肌或腹膜后损伤的不准确指标。鉴于其操作简单、并发症发生率低和准确性高，腹膜灌洗可由接受培训的外科医生安全地用于评估创伤患者。
