Department of General Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2009 Dec;8(6):597-601.
Intra-abdominal free fluid is commonly caused by injuries of solid or hollow organs in patients suffering from blunt abdominal trauma (BAT). However, it presents a diagnostic dilemma for surgeons when free fluid is unexplained, especially in stable BAT patients. This study was to analyze the incidence of such unexplained free fluid in BAT patients and its diagnostic value in abdominal organ injury.
Altogether 597 patients with BAT who had been treated at our trauma center over a 10-year period were reviewed. Stable patients with free fluid but without free air or definite organ injury on abdominal computed tomography were studied. Clinical management and operative findings were analyzed.
Thirty-four (5.70%) of the 597 patients met the inclusion criteria: 24 (4.02%) underwent therapeutic exploratory laparotomy: bowel injuries were found in 13, hepatic rupture in 3, colon rupture in 3, duodenal rupture in 2, spleen rupture in 1, pancreas rupture in 1, and gallbladder perforation in 1. In 2 patients, laparotomy was nontherapeutic. Those with moderate or large amounts of free fluid were more likely to suffer from a hollow viscus injury and have a therapeutic procedure. The mean time of hospital stay for the delayed laparotomy group was longer than that for the emergency group (19+/-5.12 vs. 12+/-2.24 days; t=2.73, P<0.01).
There was a positive correlation between the amount of unexplained free fluid and the determination of intra-abdominal organ injury. The proportion of BAT patients who required surgical intervention was high, particularly those with a moderate or large amount of free fluid, and most of them suffered from a hollow organ injury. Emergency laparotomy is recommended for these patients.
腹腔游离液在钝性腹部创伤（BAT）患者中通常由实质性或中空器官的损伤引起。然而，当游离液无法解释时，尤其是在稳定的 BAT 患者中，这给外科医生带来了诊断难题。本研究旨在分析 BAT 患者中这种不明原因游离液的发生率及其对腹部器官损伤的诊断价值。
回顾性分析了我院创伤中心 10 年间收治的 597 例 BAT 患者。研究对象为稳定的 BAT 患者，伴有游离液但腹部 CT 无游离气或明确的器官损伤。分析了临床处理和手术结果。
597 例患者中符合纳入标准的有 34 例（5.70%）：24 例行治疗性剖腹探查术，其中 13 例为肠损伤，3 例为肝破裂，3 例为结肠破裂，2 例为十二指肠破裂，1 例为脾破裂，1 例为胰腺破裂，1 例为胆囊穿孔。2 例剖腹探查术无治疗意义。游离液量中等或大量的患者更有可能遭受中空脏器损伤，并进行治疗性手术。延迟剖腹探查组的平均住院时间长于急诊剖腹探查组（19+/-5.12 与 12+/-2.24 天；t=2.73，P<0.01）。
不明原因游离液量与确定腹腔内器官损伤之间存在正相关。需要手术干预的 BAT 患者比例较高，特别是游离液量中等或大量的患者，其中大多数患者遭受中空脏器损伤。建议对这些患者行急诊剖腹探查术。
