Otomo Y, Henmi H, Mashiko K, Kato K, Koike K, Koido Y, Kimura A, Honma M, Inoue J, Yamamoto Y
Department of Critical Care and Traumatology, National Hospital Tokyo Disaster Medical Center, Tachikawa, Japan.
J Trauma. 1998 Jun;44(6):991-7; discussion 997-9. doi: 10.1097/00005373-199806000-00010.
Although diagnostic peritoneal lavage (DPL) is a well-established, reliably objective method of diagnosis of intraperitoneal injury, it is too sensitive to be used as an indicator for emergency celiotomy. Therefore, since the development of ultrasonography and advanced computed tomographic scanners, the role of DPL has been markedly reduced. Despite such remarkable advances, however, radiologic diagnosis of intestinal injury cannot always provide definitive results, and DPL may still be valuable in such instances. We have developed a new DPL criteria specifically designed to aid in the diagnosis of intestinal injury and have evaluated its effectiveness.
From August 1988 to December 1995, we performed DPL in 250 patients with blunt abdominal trauma and analyzed the diagnostic accuracy of our new criteria. We used the standard quantitative white blood cell (WBC) criterion for detection of intestinal injury supplemented by a positive-negative borderline adjusted to WBC > or = red blood cell (RBC)/150, where RBC > or = 10 x 10(4)/mm3.
Our criteria had a diagnostic sensitivity of 96.6% and a specificity of 99.4% for intestinal injury after exclusion of 57 patients in whom DPL was performed within 3 hours or after 18 hours from the time of injury. In 133 patients with hemoperitoneum, emergency celiotomy was performed in only 48; the remaining 85 patients with negative DPL based on the WBC criterion avoided surgery, and conservative management resulted in no complications.
With the proposed criteria, DPL can be used to diagnose or exclude intestinal injury even in the presence of hemoperitoneum.
尽管诊断性腹腔灌洗（DPL）是一种成熟的、客观可靠的腹腔内损伤诊断方法，但它过于敏感，不能用作急诊剖腹手术的指标。因此，自从超声检查和先进的计算机断层扫描仪出现以来，DPL的作用已显著降低。然而，尽管有这些显著进展，肠道损伤的放射学诊断并不总能提供明确的结果，在这种情况下DPL可能仍然有价值。我们制定了一种专门用于辅助诊断肠道损伤的新DPL标准，并评估了其有效性。
1988年8月至1995年12月，我们对250例钝性腹部创伤患者进行了DPL，并分析了我们新标准的诊断准确性。我们采用标准的定量白细胞（WBC）标准来检测肠道损伤，并辅以根据WBC≥红细胞（RBC）/150调整的阳性-阴性临界值，其中RBC≥10×10⁴/mm³。
在排除57例在受伤后3小时内或18小时后进行DPL的患者后，我们的标准对肠道损伤的诊断敏感性为96.6%，特异性为99.4%。在133例有腹腔积血的患者中，仅48例进行了急诊剖腹手术；其余85例根据WBC标准DPL结果为阴性的患者避免了手术，保守治疗未出现并发症。
采用所提出的标准，即使存在腹腔积血，DPL也可用于诊断或排除肠道损伤。
