Moore G P, Alden A W, Rodman G H
Methodist Hospital of Indiana, Emergency Medicine and Trauma Center, Indianapolis 46202, USA.
Acad Emerg Med. 1997 Apr;4(4):287-90. doi: 10.1111/j.1553-2712.1997.tb03550.x.
To compare the accuracies and complication rates of diagnostic peritoneal lavage (DPL) in trauma patients with and without previous abdominal surgery.
A retrospective review of DPL accuracy and complication rate was performed using all ED trauma patients who underwent DPL during 1993 as identified by the trauma registry. Care was provided at a Level-1 trauma center, a 1,100-bed, central-city teaching hospital with an annual ED census of 84,000. Records were reviewed for a history of previous surgery, DPL results, complications, mechanism of injury, and location of abdominal scars. DPL was performed using the Seldinger technique with a standard Arrow Diagnostic Peritoneal Lavage Kit using an 8-Fr catheter. Rates for patient groups with and without previous abdominal surgery were compared using Fisher's exact test. A "misclassified" DPL was defined as either a positive DPL with negative laparotomy or a negative DPL with subsequent need for laparotomy. "Complications" were defined as iatrogenic injury during the procedure or inability to obtain return of fluid during the lavage.
A total of 372 DPLs were performed; 42 in patients with previous surgery and 330 in patients without prior surgery. The groups were similar with respect to proportion with blunt trauma (95% vs 97%), positive DPL (19% vs 19%), misclassified rate (2.4% vs 1.8%), and complication rate (2.4% vs 0.9%); no significant difference was found between groups. The previous abdominal surgeries were appendectomy (n = 20), tubal ligation (n = 5), abdominal hysterectomy (n = 4), cholecystectomy (nonlaparoscopic) (n = 4), pyloric stenosis (n = 1), uterine prolapse (n = 1), undescended testis (n = 1), partial gastrectomy (n = 1), and unknown (n = 5). The analysis had a 90% power of detecting a 10% difference between the 2 groups.
The complication rate and accuracy of closed DPL in patients with previous abdominal surgery were similar to those for DPL performed in patients without previous abdominal surgery.
比较有腹部手术史和无腹部手术史的创伤患者诊断性腹腔灌洗（DPL）的准确性和并发症发生率。
回顾性分析1993年创伤登记处确定的所有在急诊科接受DPL的创伤患者的DPL准确性和并发症发生率。治疗在一级创伤中心进行，该中心是一家拥有1100张床位的市中心教学医院，急诊科年接诊量为84000人次。查阅患者记录，了解既往手术史、DPL结果、并发症、损伤机制和腹部瘢痕位置。使用标准的Arrow诊断性腹腔灌洗套件，采用Seldinger技术，使用8F导管进行DPL。采用Fisher精确检验比较有腹部手术史和无腹部手术史患者组的发生率。“分类错误”的DPL定义为DPL阳性但剖腹手术阴性或DPL阴性但随后需要剖腹手术。“并发症”定义为手术过程中的医源性损伤或灌洗时无法获得液体回流。
共进行了372次DPL；有既往手术史的患者42例，无既往手术史的患者330例。两组在钝性创伤比例（95%对97%）、DPL阳性（19%对19%）、分类错误率（2.4%对1.8%）和并发症发生率（2.4%对0.9%）方面相似；两组间未发现显著差异。既往腹部手术包括阑尾切除术（n = 20）、输卵管结扎术（n = 5）、腹部子宫切除术（n = 4）、胆囊切除术（非腹腔镜）（n = 4）、幽门狭窄（n = 1）、子宫脱垂（n = 1）、隐睾（n = 1）、部分胃切除术（n = 1），以及不明手术史（n = 5）。该分析有90%的把握检测出两组之间10%的差异。
有腹部手术史患者的闭合性DPL并发症发生率和准确性与无腹部手术史患者进行的DPL相似。
