Weinberg Jordan A, Lockhart Mark E, Parmar Abhishek D, Griffin Russell L, Melton Sherry M, Vandromme Marianne J, McGwin Gerald, Rue Loring W
Departments of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Trauma. 2010 May;68(5):1112-6. doi: 10.1097/TA.0b013e3181d769fc.
Serial computed tomography (CT) imaging of blunt splenic injury can identify the latent formation of splenic artery pseudoaneurysms (PSAs), potentially contributing to improved success in nonoperative management. However, it remains unclear whether the delayed appearance of such PSAs is truly pathophysiologic or attributable to imaging quality and timing. The objective of this study was to evaluate the influence of recent advancements in imaging technology on the incidence of the latent PSA.
Consecutive patients with blunt splenic injury over 4.5 years were identified from our trauma registry. Follow-up CT was performed for all but low-grade injuries 24 hours to 48 hours after initial CT. Incidences of both early and latent PSA formation were reviewed and compared with respect to imaging technology (4-slice vs. >or=16-slice).
A total of 411 patients were selected for nonoperative management of blunt splenic injury. Of these, 135 had imaging performed with 4-slice CT, and 276 had imaging performed with CTs of >=16-slice. Mean follow-up was 75 days (range, 1-1178 days) and 362 patients (88%) had follow-up beyond 7 days. Comparing 4-slice CT with >or=16-slice CT, there were no significant differences in the incidence of early PSA (3.7% vs. 4.7%; p = 0.91) or latent PSA (2.2% vs. 2.9%; p = 0.90). In both groups, latent PSAs accounted for approximately 38% of all PSAs observed. Splenic injury grade on initial CT was not associated with latent PSA (p = 0.54). Overall, the failure rate of nonoperative management was 7.3%. Overall mortality was 4.6%. No mortalities were related to splenic or other intra-abdominal injury.
The incidences of both early and latent PSA have remained remarkably stable despite advances in CT technology. This suggests that latent PSA is not a result of imaging technique but perhaps a true pathophysiologic phenomenon. Injury grade is unhelpful concerning the prediction of latent PSA formation.
钝性脾损伤的系列计算机断层扫描（CT）成像可识别脾动脉假性动脉瘤（PSA）的潜在形成，这可能有助于提高非手术治疗的成功率。然而，此类PSA的延迟出现究竟是真正的病理生理现象还是归因于成像质量和时机，仍不清楚。本研究的目的是评估成像技术的最新进展对潜在PSA发生率的影响。
从我们的创伤登记处确定连续4.5年中钝性脾损伤的患者。除了低级别损伤外，所有患者在初次CT检查后24小时至48小时进行随访CT检查。回顾并比较早期和潜在PSA形成的发生率与成像技术（4层CT与≥16层CT）的关系。
共选择411例钝性脾损伤患者进行非手术治疗。其中，135例患者使用4层CT进行成像，276例患者使用≥16层CT进行成像。平均随访时间为75天（范围1 - 1178天），362例患者（88%）随访时间超过7天。将4层CT与≥16层CT进行比较，早期PSA的发生率（3.7%对4.7%；p = 0.91）或潜在PSA的发生率（2.2%对2.9%；p = 0.90）均无显著差异。在两组中，潜在PSA约占所有观察到的PSA的38%。初次CT检查时的脾损伤分级与潜在PSA无关（p = 0.54）。总体而言，非手术治疗的失败率为7.3%。总死亡率为4.6%。没有死亡与脾或其他腹腔内损伤相关。
尽管CT技术有所进步，但早期和潜在PSA的发生率仍保持显著稳定。这表明潜在PSA不是成像技术的结果，而可能是一种真正的病理生理现象。损伤分级对于预测潜在PSA的形成并无帮助。
