Ng Alexander K T, Simons Richard K, Torreggiani William C, Ho Stephen G F, Kirkpatrick Andrew W, Brown D Ross G
Department of Surgery, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, British Columbia, Canada.
J Trauma. 2002 Jun;52(6):1134-40. doi: 10.1097/00005373-200206000-00019.
The optimal management of patients sustaining blunt abdominal trauma (BAT), in whom intra-abdominal free fluid but no solid organ injury is found on imaging, remains unclear. The purpose of this study was to determine the incidence and significance of this finding.
All patients presenting with suspected BAT to a provincial trauma center over a 30-month period were reviewed. A screening focused abdominal sonogram for trauma scan was obtained in every case. Stable patients with positive or indeterminate scans underwent computed tomographic scanning. Those with free fluid but without visible solid organ injury were studied. Radiologic interpretation, clinical management, and operative findings were analyzed.
Twenty-eight of 1,367 patients (2%) met inclusion criteria. Twenty-one patients (75%) underwent exploratory laparotomy, which for 16 (76%) was therapeutic: bowel injuries were found in 10 patients, mesentery injuries in 6, and injuries to solid organs in 3. In five patients, laparotomy was nontherapeutic. Those with more than a trace of free fluid were significantly more likely to have a therapeutic procedure. Seven patients (25%) were observed, of whom two failed nonoperative management and underwent therapeutic laparotomies within 24 hours of admission for missed colon, splenic, and hepatic injuries. The presence of abdominal seat belt bruising or a Chance-type fracture in the study patients was associated with a 90% and 100% therapeutic laparotomy rate, respectively. Computed tomographic scan findings were variable and were not able to predict injury severity or need for surgery.
The finding of more than trace amounts of free fluid in the absence of solid organ injury in BAT is often associated with clinically significant visceral injury. Early laparotomy is recommended for these patients.
对于钝性腹部创伤（BAT）患者，若影像学检查发现腹腔内有游离液体但无实体器官损伤，其最佳治疗方案仍不明确。本研究旨在确定这一发现的发生率及意义。
回顾了在30个月期间因疑似BAT就诊于省级创伤中心的所有患者。每例患者均进行了针对创伤的重点腹部超声筛查。扫描结果为阳性或不确定的稳定患者接受了计算机断层扫描。对那些有游离液体但无可见实体器官损伤的患者进行了研究。分析了影像学解读、临床管理及手术结果。
1367例患者中有28例（2%）符合纳入标准。21例患者（75%）接受了剖腹探查术，其中16例（76%）为治疗性手术：10例患者发现肠损伤，6例为肠系膜损伤，3例为实体器官损伤。5例患者的剖腹探查术为非治疗性。游离液体超过微量的患者进行治疗性手术的可能性显著更高。7例患者（25%）接受了观察，其中2例非手术治疗失败，因漏诊结肠、脾脏和肝脏损伤在入院后24小时内接受了治疗性剖腹探查术。研究患者中存在腹部安全带瘀伤或Chance型骨折分别与90%和100%的治疗性剖腹探查率相关。计算机断层扫描结果各异，无法预测损伤严重程度或是否需要手术。
BAT患者在无实体器官损伤的情况下发现游离液体超过微量，通常与具有临床意义的内脏损伤相关。建议对这些患者早期进行剖腹探查术。
