Rovin J D, Alford B A, McIlhenny T J, Burns R C, Rodgers B M, McGahren E D
Division of Pediatric Surgery, University of Virginia, Charlottesville 22908-0709, USA.
Am Surg. 2001 Feb;67(2):127-30.
Nonoperative management of splenic injuries in children is well accepted. However, the need for follow-up abdominal CT to document splenic healing has not been well studied. We retrospectively reviewed initial and follow-up abdominal CT examinations of pediatric patients admitted to our institution with documented splenic trauma who were managed nonoperatively. Eighty-four patients were admitted to our pediatric surgical service with splenic injury documented by CT from 1994 through 1998. The standard approach for splenic injury was bedrest for 5 to 21 days and limited activity for up to 90 days at the discretion of the attending surgeon. Thirty-five of the 84 had follow-up CTs during outpatient follow-up to evaluate and document splenic healing by CT criteria. The initial and follow-up studies were randomized and read blindly by pediatric radiologists using a modified American Association for the Surgery of Trauma grading system (I-V). The age range of the patients was 6 months to 17 years (mean +/- SE; 11 +/- 1 years). Nineteen (54%) were male and 16 (46%) were female. Causes of splenic trauma included motor vehicle accident (22), fall (seven), assault (four), pedestrian versus vehicle (one), and sports injury (one). Eight children (23%) had grade II injuries, 14 (40%) had grade III injuries, and 13 children (37%) had grade IV injuries on initial CT scan. Seven (88%) of the grade II splenic injuries were healed by 64 +/- 11 days. The remaining grade II injury had healed by 210 days. Thirteen (93%) of the grade III splenic injuries were healed by 76 +/- 7 days. The remaining grade III injury was healed by 140 days. Spleens in 10 (77%) of the 13 patients with grade IV injuries were healed by 81 +/- 8 days. Of the three remaining grade IV injuries two were healed by 173 +/- 14 days. The remaining patient's spleen was radiologically considered to have a grade III defect 91 days from the time of injury, and no further CTs were obtained. Of the 34 patients who underwent follow-up CT imaging until splenic healing was demonstrated the mean time to complete healing was 87 +/- 8 days postinjury (range 11-217 days). These data suggest that routine follow-up abdominal CTs may not be necessary to allow children to resume their normal activities after an appropriate time of restricted activity.
儿童脾损伤的非手术治疗已被广泛接受。然而，对于通过腹部CT随访来记录脾脏愈合情况的必要性，尚未得到充分研究。我们回顾性分析了我院收治的非手术治疗的小儿脾外伤患者的首次及随访腹部CT检查结果。1994年至1998年期间，共有84例经CT证实有脾损伤的患儿入住我院小儿外科。脾损伤的标准治疗方法是卧床休息5至21天，并根据主刀医生的判断，限制活动长达90天。84例患者中有35例在门诊随访期间接受了CT检查，以根据CT标准评估和记录脾脏愈合情况。首次及随访检查随机分组，由小儿放射科医生采用改良的美国创伤外科学会分级系统（I - V）进行盲法读片。患者年龄范围为6个月至17岁（平均±标准差；11±1岁）。其中19例（54%）为男性，16例（46%）为女性。脾外伤的原因包括机动车事故（22例）、跌倒（7例）、袭击（4例）、行人与车辆碰撞（1例）和运动损伤（1例）。首次CT扫描时，8例患儿（23%）为Ⅱ级损伤，14例（40%）为Ⅲ级损伤，13例患儿（37%）为Ⅳ级损伤。Ⅱ级脾损伤中有7例（88%）在64±11天愈合。其余1例Ⅱ级损伤在210天愈合。Ⅲ级脾损伤中有13例（93%）在76±7天愈合。其余1例Ⅲ级损伤在140天愈合。13例Ⅳ级损伤患者中有10例（77%）的脾脏在81±8天愈合。其余三例Ⅳ级损伤中，两例在173±14天愈合。剩余1例患者在受伤91天后，脾脏经影像学检查被认为存在Ⅲ级缺损，未再进行CT检查。在34例接受随访CT检查直至脾脏愈合的患者中，从受伤到完全愈合的平均时间为87±8天（范围11 - 217天）。这些数据表明，在适当的限制活动时间后，儿童恢复正常活动可能无需常规进行腹部CT随访。
