Phetrasuwan Warittha, Tangtiang Kaan, Vithitsuvanakul Nophadol
J Med Assoc Thai. 2014 Aug;97 Suppl 8:S15-21.
According to controversial guideline for management in case of hemodynamically stable blunt abdominal injury with microscopic hematuria. Most ofthe patients could be omittedfor abdominal computed tomography (CT). Despite high sensitivity and specificity ofabdominal CT, in addition to high medical cost, there are risks from radiation exposure and adverse reaction from use of contrast media.
To evaluate the prevalence ofKUB injury on abdominal CT in case of hemodynamically stable blunt abdominal injury with microscopic hematuria.
Forty-one studies of abdominal CT performed during 1 January 2010 and 30 June 2012 were retrospectively reviewed for KUB injury (categorized byAAST organ injury scale) by consensus oftwo experienced radiologists.
KUB injury was found in 36.6%from all selected CTstudies. Almost all cases could be managed conservatively. The cutoffpoint of microscopic hematuria at 20 cells/hpfhas sensitivity 80% and specificity 46.15%.
One-third ofthe patients have KUB injury but almost all ofthem could be conservatively managed. We proposed that the cutoffpoint of hematuria be equivalent to or greater than 20 cells/hpf to be one of the indicators for predicting KUB injury that needs radiological evaluation; but it should be carefully considered along with clinical information.
对于血流动力学稳定的钝性腹部损伤伴镜下血尿的处理,指南存在争议。大多数此类患者可无需进行腹部计算机断层扫描(CT)。尽管腹部CT具有高敏感性和特异性,但除了医疗成本高之外,还存在辐射暴露风险以及使用造影剂的不良反应。
评估血流动力学稳定的钝性腹部损伤伴镜下血尿患者腹部CT检查中泌尿道(肾脏、输尿管、膀胱)损伤的发生率。
回顾性分析2010年1月1日至2012年6月30日期间进行的41项腹部CT检查,由两位经验丰富的放射科医生通过共识对泌尿道损伤(根据美国创伤外科学会器官损伤分级)进行评估。
在所有选定的CT检查中,泌尿道损伤的发生率为36.6%。几乎所有病例均可保守治疗。镜下血尿阈值为20个细胞/每高倍视野时,敏感性为80%,特异性为46.15%。
三分之一的患者存在泌尿道损伤,但几乎所有患者均可保守治疗。我们建议血尿阈值等于或大于20个细胞/每高倍视野可作为预测需要进行放射学评估的泌尿道损伤的指标之一;但应结合临床信息仔细考虑。