Boyle E M, Maier R V, Salazar J D, Kovacich J C, O'Keefe G, Mann F A, Wilson A J, Copass M K, Jurkovich G J
Department of Surgery, Harborview Medical Center, University of Washington, Seattle 98104, USA.
J Trauma. 1997 Feb;42(2):260-5. doi: 10.1097/00005373-199702000-00013.
Historically, patients with deep posterior wounds underwent a formal celiotomy to rule out injury. Currently, we use a policy of selective management. The purpose of this review is to evaluate our experience with selective management to identify potential areas of further improvement.
This study includes 203 patients over a 10-year period. By changing from a policy of mandatory exploration to selective management the total celiotomy rate decreased from 100 to 24% and the therapeutic celiotomy rate increased from 15 to 80%.
In stable patients, a diagnostic peritoneal lavage should be performed as the initial diagnostic study. When diagnostic peritoneal lavage is negative, triple contrast computed tomography should be performed to evaluate the remaining retroperitoneal structures. Any suggestion of pericolonic extravasation of contrast or air, edema, or hemorrhage must be interpreted as a positive study and prompt consideration for operative exploration.
以往，深部后位伤口患者需行正规剖腹术以排除损伤。目前，我们采用选择性处理策略。本综述的目的是评估我们选择性处理的经验，以确定进一步改进的潜在领域。
本研究纳入了10年间的203例患者。通过从强制探查策略转变为选择性处理，剖腹术总发生率从100%降至24%，治疗性剖腹术发生率从15%升至80%。
对于病情稳定的患者，应首先进行诊断性腹腔灌洗作为初始诊断检查。当诊断性腹腔灌洗结果为阴性时，应进行三重对比计算机断层扫描以评估其余腹膜后结构。任何提示结肠周围造影剂或气体外渗、水肿或出血的情况都必须被视为检查结果阳性，并促使考虑进行手术探查。
