Padhani A R, Watson C J, Calne R Y, Dixon A K
Department of Radiology, Addenbrooke's Hospital, Cambridge.
Clin Radiol. 1992 Nov;46(5):304-10. doi: 10.1016/s0009-9260(05)80373-3.
We have retrospectively assessed the computed tomography (CT) findings in 92 patients suffering severe blunt abdominal trauma. Surgical findings and clinical follow-up were correlated with the CT findings. In nine patients CT was first used after emergency surgery and provided baseline data which was useful for further management. In two patients CT did not demonstrate small hepatic lacerations seen during previous surgery. No deaths were recorded. In 16 patients surgery followed CT within 24 h; there was good correlation between the CT and operative findings in 10 patients. However, CT failed to detect significant solid organ injury in five patients and was misleading (false positive) in another patient. There were two deaths amongst these 16 patients. Sixty-seven haemodynamically stable patients were initially managed non-operatively. Fifteen of these 67 patients had normal CT examinations; only one had subsequent laparotomy (for reasons unconnected with the trauma) where no injury was detected; there were no deaths. Of the 52 patients with an abnormal CT examination, 43 were successfully managed non-operatively. There were three deaths, including one where an injury missed at CT contributed to the demise of the patient. After an initial trial of non-operative management, the remaining six patients went to surgery where there was good concordance with the CT findings except for one missed renal injury. Active non-operative management of blunt abdominal trauma is widely accepted in haemodynamically stable patients and this report shows how CT supports this policy of surgical restraint in such cases. However, on review CT missed 13 injuries in nine patients overall; stricter attention to technique and better equipment may lead to improved results in the future.
我们回顾性评估了92例严重钝性腹部创伤患者的计算机断层扫描（CT）结果。将手术结果和临床随访情况与CT结果进行了对比。9例患者在急诊手术后首次进行CT检查，其提供的基线数据对后续治疗有帮助。2例患者的CT未显示出先前手术中发现的小肝裂伤。无死亡病例记录。16例患者在CT检查后24小时内接受了手术；其中10例患者的CT结果与手术所见有良好的相关性。然而，CT未能检测出5例患者的实质性脏器严重损伤，且在另1例患者中产生了误导（假阳性）。这16例患者中有2例死亡。67例血流动力学稳定的患者最初采用非手术治疗。这67例患者中有15例CT检查正常；仅1例随后接受了剖腹手术（与创伤无关），未发现损伤；无死亡病例。52例CT检查异常的患者中，43例成功接受了非手术治疗。有3例死亡，其中1例患者的死亡与CT漏诊的损伤有关。在最初尝试非手术治疗后，其余6例患者接受了手术，除1例肾损伤漏诊外，其余与CT结果吻合良好。血流动力学稳定的钝性腹部创伤患者广泛接受积极的非手术治疗，本报告展示了CT在此类病例中如何支持这种手术限制策略。然而，经复查，CT总共在9例患者中漏诊了13处损伤；未来更严格地关注技术和更好的设备可能会带来更好的结果。
