Coppa G F, Davalle M, Pachter H L, Hofstetter S R
Surg Gynecol Obstet. 1984 Dec;159(6):514-8.
The results of a retrospective and prospective study of patients with penetrating wounds of the back and flank showed that physical examination alone was accurate in 72 and 83 per cent, respectively. The inaccuracy was primarily due to false-negative examinations. The most commonly injured organs were the liver and kidney. The presence of gross hematuria and intravenous pyelography proved to have an accuracy rate of 95 per cent in patients studied prospectively. Peritoneal lavage, although similarly accurate (95 per cent), was associated with a 10 per cent false-negative result when the wound was located in the back. Guidelines for the management of these patients include hospital admission, careful physical examination, urinalysis by dipstick and cell count, intravenous pyelography and peritoneal lavage. Initial hypotension usually is associated with visceral injury and is an indication for exploratory laparotomy. Strict adherence to these guidelines was associated with a negative exploration rate of less than 10 per cent and a decrease in the number of patients observed with visceral injury from 50 to 6 per cent.
一项对背部和侧腹穿透伤患者的回顾性和前瞻性研究结果显示，单纯体格检查的准确率分别为72%和83%。检查不准确主要是由于假阴性检查。最常受伤的器官是肝脏和肾脏。在进行前瞻性研究的患者中，肉眼血尿的存在和静脉肾盂造影的准确率被证明为95%。腹腔灌洗虽然同样准确（95%），但当伤口位于背部时，假阴性结果发生率为10%。这些患者的处理指南包括住院、仔细的体格检查、用试纸条进行尿液分析和细胞计数、静脉肾盂造影以及腹腔灌洗。初始低血压通常与内脏损伤相关，是进行剖腹探查的指征。严格遵循这些指南使阴性探查率低于10%，且内脏损伤患者的观察例数从50%降至6%。
