Uberoi R, D'Costa H, Brown C, Dubbins P
Department of Radiology, Bristol Royal Infirmary, U.K.
J Clin Ultrasound. 1995 Jul-Aug;23(6):363-6. doi: 10.1002/jcu.1870230606.
Bowel perforation in patients undergoing laparoscopic surgery is an uncommon but serious complication. Bowel adherent to the anterior abdominal wall due to adhesions is considered a particular risk. It has been suggested that transabdominal ultrasound can reliably predict the presence of intraperitoneal adhesions. Normal bowel excursions (visceral slide) in 15 volunteers with no history of surgery or peritonitis and in 48 patients undergoing abdominal surgery were evaluated. Visceral slide during spontaneous respiration (SRSL) with manual compression (MCSL) and exaggerated respiration (ESL) was assessed in all 4 quadrants. Adhesions were found in 43 quadrants (12 in the RUQ, 6 in the LUQ, 14 in the RIF, and 11 in the LIF) in 21 patients at surgery. Reduced SRSL detected fibrous adhesions in 6 of 15 quadrants, but only 3 of 28 fibrinous adhesions, with an overall sensitivity of 21%, specificity of 94%, and accuracy of 76%. MCSL detected 9 of 15 fibrous and 9 of 28 fibrinous adhesions, with an overall sensitivity of 42%, specificity of 73.5%, and accuracy of 62%. ESL detected 6 of 15 fibrous and 3 of 28 fibrinous adhesions, with an overall sensitivity of 20%, specificity of 76%, and accuracy of 63%. Preliminary results suggest that ultrasound can detect adhesions preoperatively, but the overall sensitivity is poor and the number of false-positives and false-negatives make it unreliable for routine use.
接受腹腔镜手术的患者发生肠穿孔是一种罕见但严重的并发症。因粘连而与前腹壁粘连的肠管被认为是一种特殊风险。有人提出经腹超声可以可靠地预测腹腔内粘连的存在。对15名无手术或腹膜炎病史的志愿者以及48名接受腹部手术的患者的正常肠管蠕动（内脏滑动）进行了评估。在所有4个象限评估了在手动按压（MCSL）和深呼吸（ESL）时的自发呼吸过程中的内脏滑动（SRSL）。手术中在21名患者的43个象限发现粘连（右下腹12个，左下腹6个，右下腹14个，左下腹11个）。SRSL降低在15个象限中的6个检测到纤维性粘连，但在28个纤维蛋白性粘连中仅检测到3个，总体敏感性为21%，特异性为94%，准确性为76%。MCSL检测到15个纤维性粘连中的9个和28个纤维蛋白性粘连中的9个，总体敏感性为42%，特异性为73.5%，准确性为62%。ESL检测到15个纤维性粘连中的6个和28个纤维蛋白性粘连中的3个，总体敏感性为20%，特异性为76%，准确性为63%。初步结果表明超声可以在术前检测到粘连，但总体敏感性较差，假阳性和假阴性数量使其在常规使用中不可靠。
