General Surgery Resident at Università Degli Studi di Milano, Milan, Italy.
General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, Vimercate, MB, Italy.
Updates Surg. 2021 Apr;73(2):703-710. doi: 10.1007/s13304-020-00929-w. Epub 2020 Dec 19.
Despite its rarity, traumatic hollow viscus and mesenteric injury (HVMI) have high mortality and complication rates. There is no consensus regarding its best management. Our aim is to evaluate contrast enhanced CT (ceCT) in the screening of HVMI and its capability to assess the need for surgery. All trauma patients admitted to an urban Level 1 trauma center between 2010 and 2018 were retrospectively evaluated. Patients with ceCT scan prior to laparotomy were included. Patients requiring surgical repair of HVMI and a ceCT scan consistent with HVMI were considered true positives. Six ceCT scan criteria for HVMI were used; at least one criterion was considered positive for HVMI. Sensitivity (Sn), specificity (Sp), predictive values (PV), likelihood ratios (LR) and accuracy (Ac) of ceCT of single ceCT criteria and of the association of ceCT criteria were calculated using intraoperative findings as gold standard. Therapeutic time (TT), death probability (DP), and observed mortality (OM) were described. 114 of 4369 patients were selected for ceCT accuracy analysis; 47 were considered true positives. Sn of ceCT for HVMI was 97.9%, Sp 63.6%, PPV 66.2%, NPV 97.6%, + LR 2.69, -LR 0.03, Ac 78%; no single criterion stood out. The association of four or more criteria improved ceCT Sp to 98.5%, PPV to 95.6%, + LR to 30.5. Median TT was 2 h (IQR: 1-3 h). OM was 7.8%-not significantly higher than overall OM. CeCT in trauma has become a reliable screening test for HVMI and a valid exam to select HVMI patients for surgical exploration.
尽管创伤性空心内脏和肠系膜损伤（HVMI）较为罕见，但死亡率和并发症发生率很高。目前尚无关于其最佳治疗方法的共识。我们旨在评估增强 CT（ceCT）在 HVMI 筛查中的作用及其评估手术需求的能力。回顾性评估了 2010 年至 2018 年期间在城市一级创伤中心收治的所有创伤患者。纳入了在剖腹术前进行 ceCT 扫描的患者。将需要手术修复 HVMI 且 ceCT 扫描符合 HVMI 的患者视为真阳性。使用了 6 项 HVMI 的 ceCT 扫描标准；至少有一项标准被认为是 HVMI 的阳性标准。使用术中发现作为金标准，计算了 ceCT 单一标准和 ceCT 标准组合对 HVMI 的敏感性（Sn）、特异性（Sp）、预测值（PV）、似然比（LR）和准确性（Ac）。描述了治疗时间（TT）、死亡概率（DP）和观察死亡率（OM）。在 4369 名患者中，有 114 名患者被选中进行 ceCT 准确性分析；其中 47 名被认为是真阳性。ceCT 对 HVMI 的 Sn 为 97.9%，Sp 为 63.6%，PPV 为 66.2%，NPV 为 97.6%，+LR 为 2.69，-LR 为 0.03，Ac 为 78%；没有一个单一的标准表现突出。四项或更多标准的联合应用提高了 ceCT 的 Sp 至 98.5%，PPV 至 95.6%，+LR 至 30.5。中位 TT 为 2 小时（IQR：1-3 小时）。OM 为 7.8%-与总体 OM 无显著差异。ceCT 在创伤中已成为 HVMI 的可靠筛查试验，也是选择 HVMI 患者进行手术探查的有效检查。
