Liu M, Lee C H, P'eng F K
Emergency Surgery and Traumatology, Taipei Veterans General Hospital, Taiwan, Republic of China.
J Trauma. 1993 Aug;35(2):267-70. doi: 10.1097/00005373-199308000-00016.
From January through December 1990, a prospective study comparing the accuracy of diagnostic peritoneal lavage (DPL), abdominal computed tomographic (CT) scanning, and abdominal ultrasonographic (US) scanning was carried out. Patients with stable vital signs following their initial resuscitation coupled with equivocal physical examination findings received both CT and US scanning. A DPL was then done. If any of these three examinations produced positive findings, a laparotomy was done and the surgical findings were compared with the results of the diagnostic studies. Fifty-five patients were studied (44 men, 11 women), with a mean age of 43 years and a mean ISS of 18.5 +/- 10.5. The sensitivity, specificity, and accuracy were 100%, 84.2%, and 94.5% for DPL, 97.2%, 94.7%, and 96.4% for CT scanning, and 91.7%, 94.7%, and 92.7% for US scanning. Problems do exist in identifying isolated small intestinal perforations with ultrasonography. Since more and more trauma centers are using ultrasonography in the emergency department as a screening method in the management of patients with blunt abdominal trauma, it is important to avoid overestimating its capability. Frequent re-evaluation of the patient's condition, repeat ultrasonographic scans, diagnostic peritoneal lavage, and CT scanning are complementary and important in the diagnosis of blunt abdominal trauma.
1990年1月至12月，开展了一项前瞻性研究，比较诊断性腹腔灌洗（DPL）、腹部计算机断层扫描（CT）及腹部超声扫描（US）的准确性。初始复苏后生命体征稳定且体格检查结果不明确的患者接受了CT和US扫描。随后进行DPL。若这三项检查中有任何一项结果呈阳性，则进行剖腹手术，并将手术结果与诊断性检查结果进行比较。共研究了55例患者（44例男性，11例女性），平均年龄43岁，平均损伤严重度评分（ISS）为18.5±10.5。DPL的敏感性、特异性和准确性分别为100%、84.2%和94.5%；CT扫描分别为97.2%、94.7%和96.4%；US扫描分别为91.7%、94.7%和92.7%。超声检查在识别孤立性小肠穿孔方面确实存在问题。由于越来越多的创伤中心在急诊科将超声检查用作钝性腹部创伤患者管理中的筛查方法，因此避免高估其能力很重要。对患者病情进行频繁重新评估、重复超声扫描、诊断性腹腔灌洗及CT扫描在钝性腹部创伤的诊断中相辅相成且至关重要。
