THE ROLE OF LAPAROSCOPY IN ABDOMINAL-TRAUMA

被引:117
作者
LIVINGSTON, DH [1 ]
TORTELLA, BJ [1 ]
BLACKWOOD, J [1 ]
MACHIEDO, GW [1 ]
RUSH, BF [1 ]
机构
[1] UNIV MED & DENT NEW JERSEY,NEW JERSEY MED SCH,DEPT SURG,NEWARK,NJ 07103
关键词
D O I
10.1097/00005373-199209000-00023
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Thirty-nine hemodynamically stable trauma patients were evaluated prospectively by laparoscopy before planned celiotomy. Laparoscopy was performed using a forward-viewing laparoscope connected to two high-resolution video monitors. The mechanism of injury was blunt trauma in eight, stab wounds (SWs) in 16, and gunshot wounds (GSWs) in 15. Laparoscopy correctly identified the presence of an intraperitoneal injury in 26 patients. Six other patients had retroperitoneal injuries, five of which were seen on laparoscopy. The remaining seven patients had no demonstrable intraperitoneal or retroperitoneal injuries, did not undergo celiotomy, and were observed without morbidity. In comparison with findings at surgery, laparoscopy identified injuries to the liver in eight of ten, to the diaphragm in three of three, to the colon in two of three, to the stomach in three of three, to the kidney in one of one, to the spleen in none of three, and to the small bowel in none of four patients. Visualization of the spleen was achieved in only one patient. The extent of the hemoperitoneum was underestimated from the laparoscopic examination in all nine patients with >750 mL of peritoneal blood, four of whom had undetected active bleeding. Laparoscopy was performed easily in all patients and there were no complications associated with its use. In conclusion, the absence of an intra-abdominal injury was correctly identified with laparoscopy in 11 patients and laparoscopy may decrease the need for celiotomy in selected patients. However, the inability to "run the small bowel," visualize the spleen, and evacuate hemorrhage limits the utility of laparoscopy in determining which patients with laparoscopically visualized injuries will require celiotomy.
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页码:471 / 475
页数:5
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