Ceraldi C M, Waxman K
Department of Surgery, University of California Irvine Medical Center, Orange 92668.
Am Surg. 1990 Dec;56(12):806-10.
This study evaluated 18 patients with blunt abdominal trauma who suffered isolated mesenteric injuries, diagnosed at exploratory laparotomy. Thirteen had diagnostic peritoneal lavage (PL) as their initial diagnostic study, and five had computed tomography (CT). All patients who had positive PL were explored emergently, undergoing repair of mesenteric injuries. Three of the five patients with CT as initial studies had delayed recognition of their injuries due to incorrect initial interpretation of the scan in two, and a false negative scan in one. Two of these patients developed intestinal infarction and required bowel resection. There were no complications in the PL group related to surgery; morbidity was greater in those undergoing CT. We conclude that early laparotomy and repair of significant mesenteric injuries is necessary to reduce morbidity, and that PL is a more sensitive indicator of this injury than CT.
本研究评估了18例腹部钝性创伤患者，这些患者在剖腹探查术中被诊断为单纯肠系膜损伤。13例患者最初的诊断检查为诊断性腹腔灌洗（PL），5例患者进行了计算机断层扫描（CT）。所有PL结果为阳性的患者均接受了急诊探查，并对肠系膜损伤进行了修复。以CT作为初始检查的5例患者中，有3例因最初扫描解读错误（2例）或假阴性扫描（1例）而延迟诊断。其中2例患者发生肠梗死，需要进行肠切除。PL组无手术相关并发症；接受CT检查的患者发病率更高。我们得出结论，早期剖腹手术和修复严重肠系膜损伤对于降低发病率是必要的，并且PL比CT是这种损伤更敏感的指标。
