Lombardo G, Martelli S, Marzocchi D, Granello M, Talenti A
I Divisione di Chirurgia, Ospedale Martini, Torino.
Minerva Chir. 1994 Nov;49(11):1061-3.
The use of laparoscopic as a diagnostic instrument in blunt penetrating abdominal traumas was first proposed by some authors in the 70s. The introduction of sophisticated instrumental tests, such as CAT and echotomography (ETG), confined this method to narrow diagnostic field which was gradually less frequently used. The lively interest expressed by the surgical world and the enormous spread of laparoscopy after the end of the 80s, following the introduction of laparoscopic cholecystectomy, has prompted the renewed use of the laparoscopic technique also in those subjects with blunt abdominal trauma. Over the past 12 months the authors have used laparoscopy in 8 subjects with hemoperitoneum secondary to contusive abdominal trauma in hemodynamically stable conditions, in which instrumental test (CAT and ETG) and peritoneal lavage were positive for the presence of hematic effusion. The use of laparoscopy in 7 patients allowed a wait-and-see approach to be adopted, thus eliminating the need for explorative laparotomy. It was only necessary to proceed with laparotomy in one patient to control bleeding from a major splenic lesion.
腹腔镜作为钝性穿透性腹部创伤的诊断工具，最早是在70年代由一些作者提出的。随着先进仪器检查方法的引入，如计算机断层扫描（CAT）和超声断层扫描（ETG），这种方法的诊断范围逐渐缩小，使用频率也越来越低。80年代末腹腔镜胆囊切除术引入后，外科界对此表现出浓厚兴趣，腹腔镜技术得到广泛应用，这也促使其在钝性腹部创伤患者中重新得到使用。在过去12个月里，作者对8例因腹部挫伤导致血腹且血流动力学稳定的患者进行了腹腔镜检查，这些患者的仪器检查（CAT和ETG）及腹腔灌洗均显示有血性积液。对7例患者使用腹腔镜检查后，可采取观察等待的方法，从而避免了剖腹探查的必要性。仅对1例患者进行了剖腹手术，以控制脾脏严重损伤引起的出血。
