Borzellino G, De Manzoni G, Ricci F
Istituto di Semeiotica Chirurgica, Università di Verona, Ospedale Borgo Trento, Verona Italy.
Surg Laparosc Endosc. 1998 Aug;8(4):273-6.
The risk of visceral injury during laparoscopy occurs mainly during the creation of the pneumoperitoneum and the insertion of the first trocar and is substantially greater in patients with a previous history of laparotomic surgery or peritonitis, owing to the possible presence of abdominal wall adhesions. In this study we assessed the results of preoperative ultrasonography of the parietal wall for the diagnosis of peritoneal adhesions, through the detection of two signs unrelated to one another, for the purpose of minimizing the number of false-negative results. Ultrasonography of the parietal wall was performed preoperatively in 130 patients who had previously undergone laparotomy. The ultrasound results were transcribed in the form of a map of the abdominal wall and checked during laparoscopy. The overall diagnostic accuracy was 88.5%, the specificity was 31.8%, and the sensitivity was 100%. The hazardous laparoscopic maneuvers were performed in adhesion-free areas in all cases, and there were no cases of complications due to visceral injury.
腹腔镜检查期间内脏损伤的风险主要发生在气腹形成和第一套管针插入过程中，对于有开腹手术或腹膜炎既往史的患者，由于可能存在腹壁粘连，这种风险会显著增加。在本研究中，我们通过检测两个互不相关的征象，评估术前壁层超声检查对腹膜粘连的诊断结果，以尽量减少假阴性结果的数量。对130例曾接受开腹手术的患者进行了术前壁层超声检查。超声检查结果以腹壁图的形式记录，并在腹腔镜检查时进行核对。总体诊断准确率为88.5%，特异性为31.8%，敏感性为100%。所有病例均在无粘连区域进行危险的腹腔镜操作，没有因内脏损伤导致并发症的病例。
