Mebert R Viola, Schnüriger Beat, Candinas Daniel, Haltmeier Tobias
Am Surg. 2018 Feb 1;84(2):208-214.
Nonoperative management of blunt splenic and hepatic injuries has become the standard of care for hemodynamically stable patients. However, nonoperative management may lead to delayed complications and appropriate follow-up is therefore crucial. The aim of this systematic literature review was to assess the role of different imaging modalities in the follow-up assessment of patients with blunt splenic or hepatic injuries using the PubMed database. Eighteen studies were found to be relevant to the topic. A total of 2725 patients were enrolled in the included studies. Both retrospective and prospective studies, but no randomized controlled trials were found. In these studies, CT, ultrasound, and contrast-enhanced ultrasound were discussed. CT was the most commonly used imaging modality. Taking into account all studies included, only one patient underwent intervention due to a complication diagnosed by follow-up CT scan in the absence of clinical signs and symptoms. This equates to a total of 920 CT scans performed to diagnose one clinically nonevident complication that required intervention. Based on the reviewed literature, routine imaging follow-up CT scans may not be indicated in asymptomatic patients with lower grade blunt splenic or hepatic injuries. Contrast-enhanced ultrasound is a promising alternative imaging modality for the follow-up of these patients.
钝性脾损伤和肝损伤的非手术治疗已成为血流动力学稳定患者的标准治疗方法。然而，非手术治疗可能导致延迟并发症，因此适当的随访至关重要。本系统文献综述的目的是利用PubMed数据库评估不同成像方式在钝性脾损伤或肝损伤患者随访评估中的作用。发现18项研究与该主题相关。纳入研究共纳入2725例患者。既有回顾性研究也有前瞻性研究，但未发现随机对照试验。在这些研究中，讨论了CT、超声和对比增强超声。CT是最常用的成像方式。综合所有纳入研究，仅1例患者在无临床体征和症状的情况下因随访CT扫描诊断出并发症而接受干预。这相当于总共进行了920次CT扫描才诊断出1例需要干预的临床隐匿性并发症。基于综述文献，对于低级别钝性脾损伤或肝损伤的无症状患者，可能无需进行常规成像随访CT扫描。对比增强超声是这些患者随访的一种有前景的替代成像方式。
