Aix-Marseille University, Marseille, France.
Department of General Surgery, APHM, CHU Nord, Marseille, France.
Eur Radiol. 2019 Nov;29(11):5932-5940. doi: 10.1007/s00330-019-06212-w. Epub 2019 Apr 25.
To evaluate the performance of an early repeated computed tomography (rCT) in initially non-operated patients with blunt bowel and mesenteric injuries (BBMI).
This was a monocentric retrospective observational study from 2009 to 2017 of patients with a BBMI on initial CT (iCT). Patients initially non-operated on were scheduled for a rCT within 48 h. Initial CT and rCT diagnostic performance were compared based on a surgical injury prediction score previously described. For statistical analysis, we used the chi-square analyses for paired data (McNemar test).
Eighty-four patients (1.9% of trauma) had suspected BBMI on iCT. Among these patients, 22 (26.2%) were initially operated on, 18 (21.4%) were later operated on, and 44 (52.4%) were not operated on. The therapeutic laparotomy rate was 85%. Thirty-four patients initially non-operated on had a rCT. The absolute value of the CT scan score increased for 15 patients (44.1%). The early rCT diagnostic performance, compared with iCT, showed an increase in sensitivity (from 63.6 to 91.7%), in negative predictive value (from 77.4 to 94.7%), and in AUC (from 0.77 to 0.94).
In initially non-operated patients with BBMI lesions, the performance of an early rCT improved the sensitivity of lesion detection requiring surgical repair and the security of patient selection for non-operative treatment.
• Selective non-operative treatment for hemodynamically stable patients with blunt bowel and/or mesenteric injuries on CT is developing but remains controversial. • An early repeated CT improved the sensitivity of lesion detection requiring surgical repair and the security of patient selection for conservative treatment.
评估在最初未接受手术的钝性肠和肠系膜损伤（BBMI）患者中早期重复 CT（rCT）的性能。
这是一项 2009 年至 2017 年对初始 CT（iCT）上有 BBMI 的患者进行的单中心回顾性观察性研究。最初未接受手术的患者计划在 48 小时内进行 rCT。根据先前描述的手术损伤预测评分，比较初始 CT 和 rCT 的诊断性能。统计分析采用配对数据的卡方分析（McNemar 检验）。
84 例患者（占创伤的 1.9%）iCT 显示疑似 BBMI。其中 22 例（26.2%）最初接受手术，18 例（21.4%）后来接受手术，44 例（52.4%）未接受手术。剖腹探查率为 85%。34 例最初未接受手术的患者进行了 rCT。15 例（44.1%）患者的 CT 扫描评分绝对值增加。与 iCT 相比，早期 rCT 的诊断性能显示出对需要手术修复的病变的敏感性提高（从 63.6%提高到 91.7%）、阴性预测值提高（从 77.4%提高到 94.7%）和 AUC 提高（从 0.77 提高到 0.94）。
在最初未接受手术的 BBMI 病变患者中，早期 rCT 的应用提高了对需要手术修复的病变的检测敏感性，同时也提高了选择非手术治疗的患者的安全性。
对 CT 显示有钝性肠和/或肠系膜损伤但血流动力学稳定的患者选择性进行非手术治疗正在发展，但仍存在争议。
早期重复 CT 提高了对需要手术修复的病变的检测敏感性，同时也提高了选择保守治疗的患者的安全性。
