Walker Mark L, Akpele Ignatius, Spence Stanston D, Henderson Vernon
Department of Surgery Atlanta Medical Center and Surgical Health Collective, Atlanta, GA, USA.
Am Surg. 2012 Sep;78(9):979-85.
The precise role of repeat abdominal computed tomography (CT) imaging in the diagnosis and management of bowel injury is unclear. We reviewed 540 patients with blunt abdominal trauma managed at a Level II trauma center over a 5-year period to better define the role of repeat imaging. One hundred patients had a repeat abdominal CT scan within 72 hours of admission. These patients were young with multisystem injuries (mean ± standard deviation age, 34 ± 15 years; Injury Severity Score, 21 ± 12; Glasgow Coma Score [GCS], 12 ± 5). There were 14 patients with bowel injuries. All bowel-injured patients survived without abdominal morbidity. Time to repeat CT was shortest in the bowel injured group (20 ± 10 hours). The repeat CT was most helpful in patients with significant closed head injury (mean GCS, 3 ± 1) and in those with occult bowel injury. The repeat scan resulted in a change in clinical management in 26 patients. Regarding the presence of bowel perforation, the follow-up scan enhanced sensitivity from 30 to 82 per cent. The repeat abdominal CT is best used selectively in patients with blunt abdominal trauma and can provide clinically useful information to exclude bowel injury.
重复腹部计算机断层扫描（CT）成像在肠损伤诊断和管理中的精确作用尚不清楚。我们回顾了一家二级创伤中心在5年期间收治的540例钝性腹部创伤患者，以更好地明确重复成像的作用。100例患者在入院72小时内进行了重复腹部CT扫描。这些患者年轻，伴有多系统损伤（平均年龄±标准差，34±15岁；损伤严重度评分，21±12；格拉斯哥昏迷评分[GCS]，12±5）。有14例患者存在肠损伤。所有肠损伤患者均存活，无腹部并发症。肠损伤组重复CT的时间最短（20±10小时）。重复CT对重度闭合性颅脑损伤患者（平均GCS，3±1）和隐匿性肠损伤患者最有帮助。重复扫描导致26例患者的临床管理发生改变。关于肠穿孔的存在，随访扫描将敏感性从30%提高到了82%。重复腹部CT最好选择性地用于钝性腹部创伤患者，并且可以提供排除肠损伤的临床有用信息。
