Banz Vanessa M, Butt Muhammad U, Zimmermann Heinz, Jeger Victor, Exadaktylos Aristomenis K
Visceral Surgery and Medicine, Inselspital, Berne, University Hospital and University of Berne, Switzerland.
J Trauma Manag Outcomes. 2009 Dec 15;3:10. doi: 10.1186/1752-2897-3-10.
Whereas a non-operative approach for hemodynamically stable patients with free intraabdominal fluid in the presence of solid organ injury is generally accepted, the presence of free fluid in the abdomen without evidence of solid organ injury not only presents a challenge for the treating emergency physician but also for the surgeon in charge. Despite recent advances in imaging modalities, with multi-detector computed tomography (CT) (with or without contrast agent) usually the imaging method of choice, diagnosis and interpretation of the results remains difficult. While some studies conclude that CT is highly accurate and relatively specific at diagnosing mesenteric and hollow viscus injury, others studies deem CT to be unreliable. These differences may in part be due to the experience and the interpretation of the radiologist and/or the treating physician or surgeon.A search of the literature has made it apparent that there is no straightforward answer to the question what to do with patients with free intraabdominal fluid on CT scanning but without signs of solid organ injury. In hemodynamically unstable patients, free intraabdominal fluid in the absence of solid organ injury usually mandates immediate surgical intervention. For patients with blunt abdominal trauma and more than just a trace of free intraabdominal fluid or for patients with signs of peritonitis, the threshold for a surgical exploration - preferably by a laparoscopic approach - should be low. Based on the available information, we aim to provide the reader with an overview of the current literature with specific emphasis on diagnostic and therapeutic approaches to this problem and suggest a possible algorithm, which might help with the adequate treatment of such patients.
对于血流动力学稳定且存在实质性器官损伤并伴有腹腔内游离液体的患者，非手术治疗方法已被普遍接受，然而，腹腔内存在游离液体但无实质性器官损伤证据的情况，不仅给急诊治疗医生带来挑战，也给负责的外科医生带来挑战。尽管近年来成像技术有所进步，多排螺旋计算机断层扫描（CT）（有无造影剂）通常是首选的成像方法，但结果的诊断和解读仍然困难。虽然一些研究得出结论，CT在诊断肠系膜和中空脏器损伤方面高度准确且相对特异，但其他研究认为CT不可靠。这些差异部分可能归因于放射科医生和/或治疗医生或外科医生的经验及解读。文献检索表明，对于CT扫描显示腹腔内有游离液体但无实质性器官损伤迹象的患者该如何处理，并没有直接的答案。对于血流动力学不稳定且无实质性器官损伤的腹腔内游离液体患者，通常需要立即进行手术干预。对于腹部钝性创伤且腹腔内游离液体不止微量的患者或有腹膜炎体征的患者，手术探查——最好采用腹腔镜方法——的阈值应该较低。基于现有信息，我们旨在为读者提供当前文献综述，特别强调针对该问题的诊断和治疗方法，并提出一种可能的算法，这可能有助于对此类患者进行适当治疗。
