Killeen K L, Shanmuganathan K, Poletti P A, Cooper C, Mirvis S E
Department of Diagnostic Radiology, University of Maryland Medical System and Shock Trauma Center, Baltimore, Maryland 21201-1595, USA.
J Trauma. 2001 Jul;51(1):26-36. doi: 10.1097/00005373-200107000-00005.
The role of computed tomography in diagnosing hollow viscus injury after blunt abdominal trauma remains controversial, with previous studies reporting both high accuracy and poor results. This study was performed to determine the diagnostic accuracy of helical computed tomography in detecting bowel and mesenteric injuries after blunt abdominal trauma in a large cohort of patients.
One hundred fifty patients were admitted to our Level I trauma center over a 4-year period with computed tomographic (CT) scan or surgical diagnosis of bowel or mesenteric injury. CT scan findings were retrospectively graded as negative, nonsurgical, or surgical bowel or mesenteric injury. The CT scan diagnosis was then compared with surgical findings, which were also graded as negative, nonsurgical, or surgical.
Computed tomography had an overall sensitivity of 94% in detecting bowel injury and 96% in detecting mesenteric injury. Surgical bowel cases were correctly differentiated in 64 of 74 cases (86%), and surgical mesenteric cases were correctly differentiated from nonsurgical in 57 of 76 cases (75%).
Helical CT scanning is very accurate in detecting bowel and mesenteric injuries, as well as in determining the need for surgical exploration in bowel injuries. However, it is less accurate in predicting the need for surgical exploration in mesenteric injuries alone.
计算机断层扫描在钝性腹部创伤后诊断中空脏器损伤中的作用仍存在争议，既往研究报告其准确性既有很高的情况，也有较差的结果。本研究旨在确定螺旋计算机断层扫描在一大群钝性腹部创伤患者中检测肠道和肠系膜损伤的诊断准确性。
在4年期间，150例患者因肠道或肠系膜损伤的计算机断层扫描（CT）或手术诊断入住我们的一级创伤中心。CT扫描结果被回顾性分级为阴性、非手术性或手术性肠道或肠系膜损伤。然后将CT扫描诊断与手术结果进行比较，手术结果也被分级为阴性、非手术性或手术性。
计算机断层扫描检测肠道损伤的总体敏感性为94%，检测肠系膜损伤的总体敏感性为96%。74例手术性肠道病例中有64例（86%）被正确区分，76例手术性肠系膜病例中有57例（75%）被正确区分非手术性病例。
螺旋CT扫描在检测肠道和肠系膜损伤以及确定肠道损伤是否需要手术探查方面非常准确。然而，它在单独预测肠系膜损伤是否需要手术探查方面准确性较低。
