Ross S E, Dragon G M, O'Malley K F, Rehm C G
University of Medicine and Dentistry, Robert Wood Johnson Medical School at Camden, Cooper Hospital, New Jersey, USA.
Injury. 1995 Jul;26(6):393-4. doi: 10.1016/0020-1383(95)00058-h.
Exploratory coeliotomy is essential in the care of abdominal trauma, but negative operation has a reported morbidity rate as high as 18 per cent. Ancillary studies such as computerized tomography, diagnostic peritoneal lavage and abdominal ultrasound have improved both sensitivity and specificity of evaluation in blunt and penetrating trauma, thus decreasing the rate of negative coeliotomy. A retrospective study of 50 consecutive negative laparotomies (10.5 per cent of all trauma laparotomies) at our Trauma Center revealed a morbidity rate of 22 per cent and mortality of 6 per cent. Although the negative coeliotomy rate was lower for blunt than penetrating trauma, morbidity was significantly higher for blunt trauma. Extra-abdominal injury alone could not account for this difference. We conclude that negative coeliotomy in penetrating trauma does not carry excessive morbidity. Negative coeliotomy in blunt trauma is accompanied by high morbidity and mortality, so adjunct diagnostic procedures should be utilized in this population in an effort to minimize negative laparotomies.
剖腹探查术对于腹部创伤的治疗至关重要，但据报道阴性手术的发病率高达18%。诸如计算机断层扫描、诊断性腹腔灌洗和腹部超声等辅助检查提高了钝性和穿透性创伤评估的敏感性和特异性，从而降低了阴性剖腹探查术的发生率。我们创伤中心对连续50例阴性剖腹手术（占所有创伤剖腹手术的10.5%）进行的一项回顾性研究显示，发病率为22%，死亡率为6%。虽然钝性创伤的阴性剖腹探查术发生率低于穿透性创伤，但钝性创伤的发病率明显更高。单纯的腹部外损伤无法解释这种差异。我们得出结论，穿透性创伤中的阴性剖腹探查术不会带来过高的发病率。钝性创伤中的阴性剖腹探查术伴随着高发病率和死亡率，因此应在这一人群中采用辅助诊断程序，以尽量减少阴性剖腹手术。
