Schreiber M A, Gentilello L M, Rhee P, Jurkovich G J, Maier R V
Department of Surgery, Harborview Medical Center, Seattle, Wash., USA.
Arch Surg. 1996 Sep;131(9):954-8; discussion 958-9. doi: 10.1001/archsurg.1996.01430210052010.
To determine if computed tomographic (CT) scanning can be used to identify patients with blunt trauma, positive results of diagnostic peritoneal lavage (DPL), and a stable hemodynamic status who could be managed safely and cost-effectively without celiotomy.
Patients with blunt trauma who required an abdominal evaluation underwent DPL. Patients with a red blood cell count greater than 10(11)/L (10(5)/mm3) on lavage then underwent CT. Patients with solid organ injury alone, as detected on CT scan, were observed; those with evidence of hollow viscus injury underwent celiotomy.
Sixty-seven hemodynamically stable patients had a red blood cell count greater than 10(11)/L on DPL; 38 patients underwent subsequent CT scanning, and 29 underwent immediate celiotomy in violation of the protocol. Eleven patients in the protocol group ultimately underwent celiotomy. Overall, there were significantly fewer nontherapeutic celiotomies performed in the protocol group (2/38 vs 9/29, P < .01). There were no deaths in either group. Because DPL is less expensive than CT, limiting CT to patients with DPL-positive results and hemodynamic stability reduced the charges associated with abdominal evaluation by $580,594 over a period of 2 years.
Limiting CT to the evaluation of patients with DPL-positive results and hemodynamic stability is safe, reduces charges, and results in a lower rate of nontherapeutic celiotomies compared with DPL alone.
确定计算机断层扫描（CT）能否用于识别钝性创伤患者、诊断性腹腔灌洗（DPL）结果为阳性且血流动力学稳定的患者，这些患者无需剖腹手术即可安全且经济有效地进行治疗。
需要进行腹部评估的钝性创伤患者接受DPL。灌洗时红细胞计数大于10(11)/L（10(5)/mm3）的患者随后接受CT检查。CT扫描检测到仅存在实体器官损伤的患者进行观察；有中空脏器损伤证据的患者接受剖腹手术。
67例血流动力学稳定的患者DPL时红细胞计数大于10(11)/L；38例患者随后接受CT扫描，29例患者违反方案立即接受剖腹手术。方案组中有11例患者最终接受了剖腹手术。总体而言，方案组中进行的非治疗性剖腹手术明显更少（2/38对9/29，P < 0.01）。两组均无死亡病例。由于DPL比CT便宜，将CT检查限制在DPL结果为阳性且血流动力学稳定的患者中，在2年的时间里，与腹部评估相关的费用减少了580,594美元。
与单独使用DPL相比，将CT检查限制在评估DPL结果为阳性且血流动力学稳定的患者中是安全的，可降低费用，并降低非治疗性剖腹手术的发生率。
