Kosloske A M, Goldthorn J F
Arch Surg. 1982 May;117(5):571-5. doi: 10.1001/archsurg.1982.01380290037007.
We performed paracentesis or peritoneal lavage on 50 seriously ill infants and children in whom the diagnosis of intestinal gangrene or perforation was suspected. Thirty-four infants had necrotizing enterocolitis and 16 had other conditions. In infants with suspected intestinal gangrene, the presence of brown peritoneal fluid and/or bacteria on Gram's stain was indicative of intestinal gangrene. In infants with pneumoperitoneum, the presence of cloudy fluid with leukocytosis was indicative of gastrointestinal perforation. Using these two criteria, the accuracy of paracentesis in predicting the need for operation was 90%. When combined with clinical judgment, the accuracy rose to 97.5%. The rate of negative findings from abdominal explorations was 5%. Analysis of the peritoneal fluid may improve the timing and accuracy of the operative decision.
我们对50名疑似患有肠坏疽或穿孔的重症婴幼儿进行了腹腔穿刺或腹腔灌洗。34名婴儿患有坏死性小肠结肠炎，16名患有其他病症。在疑似肠坏疽的婴儿中，棕色腹腔积液和/或革兰氏染色发现细菌提示肠坏疽。在有气腹的婴儿中，浑浊液体伴白细胞增多提示胃肠道穿孔。使用这两条标准，腹腔穿刺预测手术需求的准确率为90%。结合临床判断时，准确率升至97.5%。腹部探查的阴性发现率为5%。分析腹腔积液可能会改善手术决策的时机和准确性。
