Salvino C K, Esposito T J, Marshall W J, Dries D J, Morris R C, Gamelli R L
Shock Trauma Institute, Loyola University Medical Center, Maywood, Illinois.
J Trauma. 1993 Apr;34(4):506-13; discussion 513-5. doi: 10.1097/00005373-199304000-00007.
This study evaluated the role and advantages of diagnostic laparoscopy (DL) compared with diagnostic peritoneal lavage (DPL) in 75 trauma patients who were prospectively studied with DL followed by DPL. Of these, 59 patients had blunt injuries and 16 stab wounds. Seventy patients (93%) had the procedures performed in the emergency department (ED); 41 (59%) of these were awake and under local anesthesia. Forty-two patients had negative DPL and DL results with no subsequent sequelae. Twenty-three patients had negative DPL results and abnormal DL results. Of these, 20 were managed nonsurgically, and three (DPL < 10,000 RBC) underwent surgery based solely on DL findings of diaphragmatic lacerations from stab wounds. These were repaired. All 23 had an uneventful course. Three patients had positive DPL and insignificant DL findings. Laparotomy and DL findings correlated. A splenectomy for iatrogenic injury unrelated to DL and two nontherapeutic laparotomies were performed. Seven patients demonstrated both positive DPL and significant DL findings, and all had therapeutic laparotomies. Management based on DL rather than DPL would potentially have improved care in 8% of cases (6 of 75). Reliance on DL improved care in 19% (3 of 16) of patients with stab wounds and possibly could have in 3% (2 of 59) of those with blunt injuries. Management using DL would have potentially improved care in 30% (3 of 10) of patients with positive DPL findings and 5% (3 of 65) with negative DPL findings. Diagnostic laparoscopy can be performed safely in stable patients under local anesthesia in the ED. It offers no advantage over DPL as a primary assessment tool in blunt trauma. It does have advantages in the management of stab wounds. Diagnostic laparoscopy has a role in redefining DPL criteria for laparotomy and, in selected patients, as an adjunct to DPL, allowing further diagnosis and potentially the treatment of injuries without laparotomy.
本研究评估了诊断性腹腔镜检查（DL）与诊断性腹腔灌洗（DPL）相比在75例创伤患者中的作用和优势，这些患者前瞻性地先接受DL检查，随后接受DPL检查。其中，59例为钝性损伤，16例为刺伤。70例患者（93%）在急诊科（ED）接受了这些检查；其中41例（59%）在清醒状态下接受局部麻醉。42例患者DPL和DL结果均为阴性，且无后续后遗症。23例患者DPL结果为阴性，DL结果异常。其中，20例接受非手术治疗，3例（DPL红细胞计数<10,000）仅根据DL发现的刺伤导致的膈肌裂伤接受手术治疗。这些损伤均得到修复。所有23例患者病程均顺利。3例患者DPL结果为阳性，DL结果不明显。剖腹手术结果与DL结果相关。进行了1例与DL无关的医源性损伤脾切除术和2例非治疗性剖腹手术。7例患者DPL和DL结果均为阳性，均接受了治疗性剖腹手术。基于DL而非DPL的管理可能在8%的病例（75例中的6例）中改善治疗。在刺伤患者中，依赖DL改善了19%（16例中的3例）的治疗，在钝性损伤患者中可能改善了3%（59例中的2例）的治疗。使用DL进行管理可能在30%（10例中的3例）DPL结果为阳性的患者和5%（65例中的3例）DPL结果为阴性的患者中改善治疗。诊断性腹腔镜检查可在急诊科对病情稳定的患者在局部麻醉下安全进行。作为钝性创伤患者的主要评估工具，它与DPL相比并无优势。它在刺伤的管理中具有优势。诊断性腹腔镜检查在重新定义剖腹手术的DPL标准方面具有作用，并且在选定的患者中，作为DPL的辅助手段，可在不进行剖腹手术的情况下进一步诊断并可能治疗损伤。
