Corzo Camila, Murdock Alan, Alarcon Louis, Puyana Juan C
Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Am Surg. 2016 Apr;82(4):314-8.
Mesenteric hematomas may present as a radiologic finding after blunt abdominal trauma that may be associated with surgically significant mesenteric and/or bowel injury. The question of whether to operate or not to operate on patients with mesenteric hematoma remains a topic of debate, especially with the improved imaging technology. This study sought to identify clinical and radiological characteristics for patient selection for operative management (OM) of mesenteric hematoma. A retrospective review of 33 adults with blunt abdominal trauma and mesenteric hematoma on CT scan (2009-2012) was performed. Patients with other intra-abdominal injuries, penetrating trauma, isolated gastric hematoma, contrast extravasation, extraluminal air, and Glasgow Coma Scale < 14 were excluded. Patients requiring surgical treatment within 24 hours of admission were compared with those who did not using chi-squared test, Fisher's exact test, and t test. Parameters included age, gender, race, Glasgow Coma Scale, vital signs, pain, tenderness, ecchymosis, Injury Severity Score, length of stay, and inhospital mortality. Logistic regression was used to determine positive associations with OM. Of the 33 patients, 19 underwent OM and 14 did not. Both groups were similar at baseline. Regression analysis revealed association for pain [odds ratio (OR) = 9.6, confidence interval (CI) = 1.8-49.9, P < 0.01], tenderness (OR = 32, CI = 4.6-222.2, P < 0.01), and free fluid (OR = 10.3, CI = 1.8-60, P < 0.01) with need for operative intervention. Nonoperative management patients had 100 per cent success rate. Of the OM patients, 100 per cent underwent therapeutic laparotomies. Findings of mesenteric hematoma on CT scan in examinable patients with no abdominal pain, tenderness, or free fluid predict successful nonoperative management.
肠系膜血肿可能表现为钝性腹部创伤后的影像学表现，这可能与具有手术意义的肠系膜和/或肠损伤相关。对于肠系膜血肿患者是否进行手术的问题仍然是一个有争议的话题，尤其是随着成像技术的改进。本研究旨在确定用于肠系膜血肿手术治疗（OM）患者选择的临床和放射学特征。对2009年至2012年期间33例经CT扫描诊断为钝性腹部创伤和肠系膜血肿的成人患者进行了回顾性研究。排除有其他腹部损伤、穿透性创伤、孤立性胃血肿、造影剂外渗、腔外气体以及格拉斯哥昏迷评分<14的患者。将入院后24小时内需要手术治疗的患者与不需要手术治疗的患者进行比较，采用卡方检验、Fisher精确检验和t检验。参数包括年龄、性别、种族、格拉斯哥昏迷评分、生命体征、疼痛、压痛、瘀斑、损伤严重程度评分、住院时间和住院死亡率。采用逻辑回归确定与手术治疗的正相关关系。33例患者中，19例接受了手术治疗，14例未接受手术治疗。两组在基线时相似。回归分析显示疼痛[比值比（OR）=9.6，置信区间（CI）=1.8 - 49.9，P<0.01]、压痛（OR = 32，CI = 4.6 - 222.2，P<0.01）和游离液体（OR = 10.3，CI = 1.8 - 60，P<0.01）与手术干预需求相关。非手术治疗患者成功率为100%。手术治疗患者中，100%接受了治疗性剖腹手术。在无腹痛、压痛或游离液体的可检查患者中，CT扫描发现肠系膜血肿预示非手术治疗成功。
