Livingston C D, Sirinek K R, Levine B A, Aust J B
Arch Surg. 1982 May;117(5):670-4. doi: 10.1001/archsurg.1982.01380290116020.
Nonoperative management of splenic trauma is receiving increasing support following delineation of the spleen's role in infection. Controversy regarding the proper management of this injury led us to study retrospectively 236 consecutive patients with splenic trauma. Blunt trauma occurred in the majority (161); the remainder suffered penetrating abdominal injury secondary to gunshot or stab wounds. Diagnostic peritoneal lavage was accurate in establishing splenic injury in blunt trauma (no false-positive, but three false-negative findings). Associated intra-abdominal injury occurred in 48% and 92% of patients with blunt and penetrating trauma, respectively. Diagnostic peritoneal lavage is an accurate method for establishing an intra-abdominal injury and the need for abdominal exploration in patients with blunt abdominal trauma. Because of the high rate of associated intra-abdominal injury in splenic trauma, nonoperative management can be expected to result in a disturbing incidence of missed intra-abdominal injury in patients with abnormal peritoneal lavage findings.
随着脾脏在感染中作用的明确，脾外伤的非手术治疗得到了越来越多的支持。关于这种损伤的恰当处理存在争议，这促使我们对236例连续的脾外伤患者进行回顾性研究。大多数（161例）为钝性外伤；其余患者因枪伤或刺伤导致腹部穿透伤。诊断性腹腔灌洗在诊断钝性外伤中的脾损伤方面很准确（无假阳性，但有3例假阴性结果）。钝性和穿透性外伤患者分别有48%和92%发生了相关的腹内损伤。诊断性腹腔灌洗是诊断腹内损伤以及确定钝性腹部外伤患者是否需要进行腹部探查的一种准确方法。由于脾外伤患者腹内相关损伤的发生率很高，对于腹腔灌洗结果异常的患者，非手术治疗可能会导致令人不安的腹内损伤漏诊率。
