Mirvis S E, Whitley N O, Gens D R
Department of Diagnostic Radiology, University of Maryland Medical System, Baltimore 21201.
Radiology. 1989 Apr;171(1):33-9. doi: 10.1148/radiology.171.1.2928544.
Nonsurgical management of blunt splenic injury in children is a well-established method to salvage splenic function; however, nonsurgical management of adult blunt splenic trauma remains controversial. To assess the value of preoperative abdominal CT in predicting the outcome of blunt splenic injury in adults, a CT-based injury-severity score consisting of four grades was devised and applied in 39 adult patients with blunt splenic injury as the sole or predominant intraperitoneal injury detected with preoperative CT. While patients with high grades of splenic injury generally required early surgery, eight (35%) of 23 patients with initial grade 3 or 4 injury were treated successfully without surgery, and four (29%) of 15 patients with grade 1 or 2 injury initially treated nonsurgically required delayed celiotomy (n = 3) or emergency rehospitalization. Results show that while CT remains an accurate method of identifying and quantifying initial splenic injury, as well as documenting progression or healing of critical injury, CT cannot reliably help predict the outcome of blunt splenic injury in adults. Treatment choices should therefore be based on the hemodynamic status of the patient and results of serial laboratory and bedside assessments.
儿童钝性脾损伤的非手术治疗是一种公认的保留脾功能的方法；然而，成人钝性脾外伤的非手术治疗仍存在争议。为评估术前腹部CT在预测成人钝性脾损伤预后方面的价值，设计了一种基于CT的由四个等级组成的损伤严重程度评分，并应用于39例术前CT检查发现钝性脾损伤为唯一或主要腹腔内损伤的成年患者。虽然脾损伤程度高的患者通常需要早期手术，但23例初始损伤为3级或4级的患者中有8例（35%）未经手术成功治疗，15例初始非手术治疗的1级或2级损伤患者中有4例（29%）需要延迟开腹手术（n = 3）或紧急再次住院。结果表明，虽然CT仍然是识别和量化初始脾损伤以及记录严重损伤进展或愈合情况的准确方法，但CT不能可靠地帮助预测成人钝性脾损伤的预后。因此，治疗选择应基于患者的血流动力学状态以及系列实验室检查和床边评估结果。
