Alyono D, Morrow C E, Perry J F
Surgery. 1982 Oct;92(4):751-7.
The criteria for declaring the results of a diagnostic peritoneal lavage (DPL) positive have been controversial. Lowered cell count criteria result in increased sensitivity, decreased specificity, and altered accuracy. Consecutive lavages on 105 patients with penetrating trauma (PT) to the lower chest and abdomen (48 gunshot wounds and 57 stab wounds) and 1812 patients with blunt abdominal trauma (BT) were studied. Varied cell count criteria were analyzed. The best criteria for BT were as follows: positive, lavage fluid red blood cells (LRBCs) greater than 100,000/mm3 or lavage fluid white blood cells (LWBCs) greater than 500/mm3; indeterminate, LRBCs 50,000/mm3 to 100,000/mm3 or LWBCs 100 to 500/mm3; and negative, LRBCs less than 50,000/mm3 and LWBCs less than 100/mm3. Based on these criteria the accuracy of the test was 99.1%. The highest accuracy would be achieved for PT if the criteria were as follows: positive, LRBCs greater than 50,000/mm3 or LWBCs greater than 500/mm3; indeterminate, LRBCs 25,000 to 50,000/mm3 or LWBCs 100 to 500/mm3; negative, LRBCs less than 25,000/mm3 and LWBCs less than 100/mm3. Based on these criteria the accuracy of the test for PT would range from 96.2% (101 of 105) to 98.1% (103 of 105), depending on the results of repeat lavage for two patients with indeterminate initial lavages. The standard lavage criteria were the best for BT and achieved the highest accuracy. However, the LRBC criteria should be lowered for PT.
诊断性腹腔灌洗（DPL）结果呈阳性的判定标准一直存在争议。降低细胞计数标准会导致敏感性增加、特异性降低以及准确性改变。对105例下胸部和腹部穿透伤（PT）患者（48例枪伤和57例刺伤）以及1812例钝性腹部创伤（BT）患者进行了连续灌洗研究。分析了不同的细胞计数标准。BT的最佳标准如下：阳性，灌洗液红细胞（LRBC）大于100,000/mm³ 或灌洗液白细胞（LWBC）大于500/mm³；不确定，LRBC为50,000/mm³ 至100,000/mm³ 或LWBC为100至500/mm³；阴性，LRBC小于50,000/mm³ 且LWBC小于100/mm³。基于这些标准，该检查的准确性为99.1%。对于PT，如果标准如下，将达到最高准确性：阳性，LRBC大于50,000/mm³ 或LWBC大于500/mm³；不确定，LRBC为25,000至50,000/mm³ 或LWBC为100至500/mm³；阴性，LRBC小于25,000/mm³ 且LWBC小于100/mm³。基于这些标准，PT检查的准确性将在96.2%（105例中的101例）至98.1%（105例中的103例）之间，具体取决于两名初始灌洗结果不确定患者的重复灌洗结果。标准灌洗标准对BT是最佳的，并实现了最高准确性。然而，对于PT，LRBC标准应降低。
