Alsayali Mashal M, Atkin Chris, Winnett Jason, Rahim Reza, Niggemeyer Louise E, Kossmann Thomas
Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia.
National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
Eur J Trauma Emerg Surg. 2009 Oct;35(5):482. doi: 10.1007/s00068-009-8078-4. Epub 2009 Jul 4.
The incidence of blunt bowel and mesenteric injury (BBMI) has increased recently in blunt abdominal trauma, possibly due to an increasing number of high-speed motor accidents and the use of seat belts.
Our aim was to identify the factors determining the time of surgical intervention and how they affect the outcome of the patient with BBMI. This was achieved by reviewing our experience as a major Victorian trauma service in the management of bowel and mesenteric injuries and comparing this to the experiences reported in the literature.
A retrospective study reviewing 278 consecutive patients who presented to the Alfred trauma center with blunt bowel and mesenteric injuries over a 6-year period.
The patient cohort comprised 278 patients with BBMI (66% were male, 34% were female), of whom 80% underwent a laparotomy, 17% were treated conservatively and 3% were diagnosed post-mortem. In terms of time from admission to laparotomy, 67% were treated within 0-4 h, 9% within 4-8 h, 3% within 8-12 h, 10% within 12-24 h, 4% within 24-48 h and 7% at >48 h. A focused abdominal sonography for trauma (FAST) was performed in 86 patients, of whom 51% had a positive FAST, 44% had a negative FAST and 4% had an equivocal FAST. Overall, 13% of the patient cohort did not have a FAST. Computerized tomography (CT) scans were undertaken preoperatively in 68% of the patients, revealing free gas (22% of patients), bowel-wall thickening (31%), fat and mesenteric stranding or hematoma (38%) and free fluid with no solid organ injury (43%).
The timing of surgical intervention in cases of BBMI is mostly determined by the clinical examination and the results of the helical CT scan findings. The FAST lacks sensitivity and specificity for identifying bowel and mesenteric trauma. A delayed diagnosis of > 48 h has a significantly higher bowelrelated morbidity but not mortality.
钝性肠管及肠系膜损伤（BBMI）在钝性腹部创伤中的发生率近来有所上升，这可能归因于高速机动车事故数量的增加以及安全带的使用。
我们的目的是确定决定手术干预时机的因素，以及这些因素如何影响BBMI患者的预后。通过回顾我们作为维多利亚州主要创伤服务机构在肠管及肠系膜损伤管理方面的经验，并与文献报道的经验进行比较来实现这一目标。
一项回顾性研究，对连续6年内在阿尔弗雷德创伤中心就诊的278例钝性肠管及肠系膜损伤患者进行了分析。
患者队列包括278例BBMI患者（66%为男性，34%为女性），其中80%接受了剖腹手术，17%接受保守治疗，3%为尸检确诊。就从入院到剖腹手术的时间而言，67%在0 - 4小时内接受治疗，9%在4 - 8小时内，3%在8 - 12小时内，10%在12 - 24小时内，4%在24 - 48小时内，7%在>48小时。对86例患者进行了创伤重点腹部超声检查（FAST），其中51%的FAST结果为阳性，44%为阴性，4%为可疑。总体而言，13%的患者队列未进行FAST检查。68%的患者术前进行了计算机断层扫描（CT），显示有游离气体（22%的患者）、肠壁增厚（31%）、脂肪及肠系膜条索状影或血肿（38%）以及无实质性器官损伤的游离液体（43%）。
BBMI病例的手术干预时机主要由临床检查和螺旋CT扫描结果决定。FAST对识别肠管及肠系膜创伤缺乏敏感性和特异性。延迟诊断>48小时会显著增加肠道相关发病率，但不会增加死亡率。
