Ivatury R R, Simon R J, Stahl W M
Department of Surgery, New York Medical College and Lincoln Medical & Mental Health Center, Bronx.
J Trauma. 1993 Jun;34(6):822-7; discussion 827-8. doi: 10.1097/00005373-199306000-00013.
One hundred hemodynamically stable patients with penetrating abdominal trauma (65, stab wounds, 35, gunshot wounds) were evaluated with laparoscopy. Sixty percent of the patients had wounds in the thoracoabdominal area or the upper abdominal quadrants and 25% had injuries located in the lower abdomen and flanks. Fifteen percent had epigastric wounds. Twenty-two stabs and 21 gunshots had not penetrated the peritoneum (negative laparoscopic results). Fifty-seven patients had peritoneal penetration and were noted to have hemoperitoneum only (n = 14), hemoperitoneum and solid organ injuries (n = 23), diaphragmatic lacerations (n = 17), and hollow viscus injuries (n = 2) on laparoscopic examination. Three of the 57 patients, one with omental herniation only and two with low grade nonbleeding lacerations of the liver, were managed uneventfully without laparotomy. The remaining 54 patients underwent laparotomy with confirmation of the laparoscopic findings. Seven patients (three with stab wounds and four with gunshots) had additional GI tract injuries seen at laparotomy. The diagnostic accuracy of laparoscopy was excellent for hemoperitoneum, solid organ injuries, diaphragmatic lacerations, and retroperitoneal hematomas. For GI injuries, laparoscopy was found to have a 100% specificity but only a 18% sensitivity. The majority of these discordant findings occurred in epigastric SWs and flank and lower quadrant GSWs, all in patients with undetected hollow viscus injuries. The major role of laparoscopy in penetrating abdominal trauma is in avoiding unnecessary laparotomy in tangential SWs and GSWs. It is excellent for evaluating the diaphragm in thoracoabdominal wounds. Caution is urged in excluding hollow viscus injuries based on laparoscopy.
对100例血流动力学稳定的腹部穿透伤患者（65例刺伤，35例枪伤）进行了腹腔镜检查评估。60%的患者伤口位于胸腹区域或上腹部象限，25%的患者伤口位于下腹部和侧腹。15%的患者有上腹部伤口。22处刺伤和21处枪伤未穿透腹膜（腹腔镜检查结果为阴性）。57例患者腹膜被穿透，腹腔镜检查发现仅存在血腹（n = 14）、血腹合并实体器官损伤（n = 23）、膈肌裂伤（n = 17）和中空脏器损伤（n = 2）。57例患者中有3例，1例仅为网膜疝，2例为肝脏低级别无出血性裂伤，未经剖腹手术而顺利处理。其余54例患者接受了剖腹手术，腹腔镜检查结果得到证实。7例患者（3例刺伤和4例枪伤）在剖腹手术中发现有额外的胃肠道损伤。腹腔镜检查对血腹、实体器官损伤（n = 23）、膈肌裂伤和腹膜后血肿的诊断准确性极佳。对于胃肠道损伤，腹腔镜检查的特异性为100%，但敏感性仅为18%。这些不一致的发现大多发生在上腹部刺伤和侧腹及下腹部象限枪伤中，所有这些患者均未检测到中空脏器损伤。腹腔镜检查在腹部穿透伤中的主要作用是避免对切线型刺伤和枪伤进行不必要的剖腹手术。它在评估胸腹伤口的膈肌方面表现出色。基于腹腔镜检查排除中空脏器损伤时需谨慎。
