Le Neel J C, Guiberteau B, Khosrovani C, Bochereau C, Kohen M, Plattner V, Héloury Y
Clinique chirurgicale A, Hôtel-Dieu, Nantes.
Chirurgie. 1991;117(5-6):437-44.
From 1985 to 1990, we treated 155 patients presenting with a hemoperitoneum secondary to a splenic or hepatic injury (diagnosis established by sonography, puncture and washout and/or laparotomy). These were 39 children and 116 young adults (average age 33 years). Fifty-eight of them (37%) suffered from multiple injuries (11 children, 47 adults). Splenic lesions were observed in 110 cases and hepatic lesions in 45. Ninety-one patients were operated, 55 in emergency and 36 later, while a watch-and-wait policy was applied to 64 (42%), with repeated clinical and complementary (ultrasound and/or CT) examinations. The indication for surgery was based on the clinical findings and the necessity of blood transfusion (more than 40 ml/kg/24 h in children, more than 2 to 5 U/24 h in adults, according to the context). This attitude allowed us to avoid operating two-thirds of the children and one third of the adults. We assess the limitations of this method.
1985年至1990年期间，我们共治疗了155例因脾或肝损伤继发腹腔积血的患者（通过超声、穿刺冲洗和/或剖腹手术确诊）。其中有39名儿童和116名青年成人（平均年龄33岁）。他们中有58人（37%）遭受多处损伤（11名儿童，47名成人）。观察到脾损伤110例，肝损伤45例。91例患者接受了手术，其中55例为急诊手术，36例为择期手术，而64例（42%）采用了观察等待策略，并进行了反复的临床及辅助检查（超声和/或CT）。手术指征基于临床发现以及输血的必要性（儿童超过40 ml/kg/24小时，成人根据具体情况超过2至5 U/24小时）。这种方法使我们避免了三分之二的儿童患者和三分之一的成人患者接受手术。我们评估了该方法的局限性。
