Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
R. Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD, 21201, USA.
Abdom Radiol (NY). 2019 Jul;44(7):2648-2655. doi: 10.1007/s00261-019-02000-8.
To compare the utility of abdominopelvic fluid volume measurements with established computed tomography signs for refractory post-traumatic abdominal compartment syndrome.
This retrospective observational cohort study included 64 consecutive adult trauma patients with preoperative CT and diagnosis of refractory abdominal compartment syndrome requiring decompressive laparotomy at a level I trauma referral center between 2004 and 2014. We hypothesized that abdominal fluid volume measurements would be more predictive of the need for early laparotomy than previously described conventional CT signs of refractory ACS. Abdominopelvic fluid volumes were determined quantitatively using semi-automated segmentation software. The following conventional imaging parameters were recorded: abdominal anteroposterior:transverse ratio (round belly sign); infrahepatic vena cava diameter; distal abdominal aortic diameter; largest single small bowel wall diameter; hydronephrosis, inguinal herniation; and mesenteric and body wall edema. For outcome analysis, patients were stratified into two groups: those who underwent early (< 24 h) and late (≥ 24 h) decompressive laparotomy following CT. Correlation analysis, comparison of means, and multivariate logistic regression were performed.
Abdominal fluid volumes (p = 0.001) and anteroposterior:transverse ratio (p = 0.009) were increased and inferior vena cava diameter (p = 0.009) was decreased in the early decompressive laparotomy group. Multivariate analysis including conventional CT variables, fluid volumes, and laboratory values revealed abdominal fluid volumes (p = 0.012; Δ in log odds of 1.002/mL) as the only independent predictor of early decompressive laparotomy.
Segmented abdominopelvic free fluid volumes had greater predictive utility for decision to perform early decompressive laparotomy than previously described ACS-related CT signs in trauma patients who developed refractory abdominal compartment syndrome.
比较经腹盆腔液体量测量与已建立的 CT 征象在创伤后难复发性腹腔间隔室综合征（ACS）中的应用价值。
本回顾性观察性队列研究纳入了 2004 年至 2014 年期间在一家一级创伤中心接受术前 CT 检查且诊断为难复发性 ACS 需行减压剖腹术的 64 例连续成年创伤患者。我们假设，与之前描述的难复发性 ACS 常规 CT 征象相比，腹盆腔液体量测量更能预测早期剖腹术的必要性。使用半自动分割软件对腹盆腔液体量进行定量测定。记录以下常规影像学参数：腹部前后径/横径比（“圆腹征”）；肝下下腔静脉直径；腹主动脉远端直径；最大单个小肠壁直径；肾积水、腹股沟疝；肠系膜及腹壁水肿。为了进行结局分析，将患者分为两组：一组接受 CT 后 24 小时内（早期）行减压剖腹术，另一组接受 CT 后 24 小时以上（晚期）行减压剖腹术。进行相关性分析、均值比较和多变量逻辑回归分析。
在早期减压剖腹术组中，腹盆腔液体量（p = 0.001）和前后径/横径比（p = 0.009）增加，下腔静脉直径（p = 0.009）减小。包括常规 CT 变量、液体量和实验室值在内的多变量分析显示，腹盆腔液体量（p = 0.012；log 优势比的变化量为 1.002 /mL）是早期减压剖腹术的唯一独立预测因素。
与创伤后发生难复发性 ACS 的患者相关的已描述 CT 征象相比，分段测量经腹盆腔游离液体量对决定行早期减压剖腹术具有更大的预测价值。
