腹腔镜诊断性腹腔灌洗对腹部刀刺伤的临床诊断

摘要

Objective To assess the role of combined use of laparoscopy with diagnostic peritoneal lavage (DPL) in the diagnosis of abdominal stab injury (ASI). Methods From March 2005 to June 2010,21 cases of abdominal and thoracoabdominal stab injuries were analyzed retrospectively.All the cases were diagnosed laparoscopically first.If no significant injury was detected,1 000 ml of normal saline was infused through the abdominal trocar into the peritoneal cavity and routine/regular study on RBCs,WBC,amylase and bile of the effluent fluid was made. Results Laparoscopic diagnosis was positive in five cases,including two cases of diaphragmatic injuries,one traumatic bleeding of liver capsule,one small intestinal perforation and one stomach wall perforation.Laparoscopic diagnosis was negative in 16 cases,of which two were detected as intestinal perforation and repaired by laparotomy.The operation time was (120 ± 35.6) min and the hospital stay was (5.3 ± 3.4) d.There were no major complications after operation. Conclusion Combining the visual advantage of laparoscopy with the sensitivity and specificity of DPL can effectively improve the diagnosis of ASI.%目的 评估联合使用腹腔镜诊断性腹腔灌洗对腹部刀刺伤的临床诊断价值. 方法 对2005年3月- 2010年6月21例腹部及胸腹联合区刀刺伤患者进行回顾性研究.所有患者先接受腔镜探查,如探查中未发现明确脏器损伤,则经套管针注入等渗盐水灌洗腹腔,并对灌洗液中RBC、WBC、胰淀粉酶(AMY)、胆汁成分行常规诊断分析. 结果 腔镜探查阳性5例,其中膈肌损伤2例,肝包膜外伤出血1例,小肠穿孔1例,胃壁穿孔1例.腔镜探查阴性16例,其中2例经腹腔灌洗检查后转开腹探查证实为小肠穿孔,并行肠修补术.手术时间(120.0±35.6)min,住院时间(5.3±3.4)d,无术后并发症. 结论 腹腔镜诊断性腹腔灌洗术将腹腔镜可视化特点与腹腔灌洗术高敏感性和特异性的优势相结合,能够有效运用于临床腹部刀刺伤的伤情诊断.