Delgado Millán M A, Deballon P O
Department of Surgery, Hospital Universitario de Getafe, Spain.
World J Surg. 2001 Nov;25(11):1397-402. doi: 10.1007/s00268-001-0139-8.
There is a marked trend toward nonoperative management of abdominal trauma. This has been possible thanks to the advances in imaging and interventional techniques. In this work we review in which way computed tomography (CT) abdominal scans, angiography, and endoscopic retrograde cholangiopancreatography (ERCP) can guide the nonoperative management of hepatic and splenic trauma. The CT abdominal scan with intravenous contrast is the "departure imaging" of choice for the nonoperative management of hepatic and splenic trauma in the hemodynamically stable patient. It is the most accurate test for detecting, defining, and characterizing these injuries, the associated hemoperitoneum, and other abdominal abnormalities (the hollow viscus injuries missed on the CT scan were detected by clinical parameters and had no negative consequences in the outcome). It has an accuracy of more than 95% for these injuries, but CT grading alone cannot decide which patient can be treated conservatively and which patient requires surgery. Its usefulness for follow-up seems challenging. Angiography can be therapeutic, thereby avoiding surgery (some report that angiography can be performed even in patients with active bleeding as damage control); if vessel injury, active bleeding or hemobilia are suspected on the basis of a CT scan in a stable patient, angiography should be carried out. ERCP should be performed in patients with suspected injury to the biliary tree, even with normal iminodiacetic acid radionuclide scanning (HIDA) if symptoms persist. A biliary stent can be placed. Indications for angiography and ERCP remain unclear.
腹部创伤的非手术治疗有明显的趋势。这得益于成像和介入技术的进步。在这项工作中，我们回顾计算机断层扫描（CT）腹部扫描、血管造影和内镜逆行胰胆管造影（ERCP）如何能够指导肝脾创伤的非手术治疗。对于血流动力学稳定的患者，静脉注射造影剂的CT腹部扫描是肝脾创伤非手术治疗的首选“起始成像”。它是检测、界定和描述这些损伤、相关腹腔积血及其他腹部异常情况（CT扫描漏诊的中空脏器损伤通过临床参数检测到，且对预后无不良影响）最准确的检查。对于这些损伤，其准确率超过95%，但仅靠CT分级无法决定哪些患者可进行保守治疗，哪些患者需要手术。其在随访方面的作用似乎具有挑战性。血管造影可具有治疗作用，从而避免手术（一些报告称，即使是有活动性出血的患者作为损伤控制也可进行血管造影）；如果根据CT扫描怀疑稳定患者存在血管损伤、活动性出血或胆道出血，应进行血管造影。对于疑似胆道树损伤的患者，即使亚氨基二乙酸放射性核素扫描（HIDA）正常但症状持续，也应进行ERCP。可放置胆道支架。血管造影和ERCP的适应证仍不明确。
