Donohue J H, Federle M P, Griffiths B G, Trunkey D D
J Trauma. 1987 Jan;27(1):11-7. doi: 10.1097/00005373-198701000-00003.
Twenty-four patients with signs on computed tomography (CT) of mesenteric or intestinal injury were treated over a 5-year period (1980-1984). All patients were the victims of blunt abdominal trauma. Nine patients with CT evidence of mesenteric or bowel hematomas were observed without adverse outcome. Fifteen were operatively explored, with 14 having injuries similar to the findings on the preoperative CT scans. In the group that had surgery, either thickened bowel or free intraperitoneal fluid (blood or less dense fluid) or both were present in all but one patient. Extraluminal air (three cases) or Gastrografin (Squibb) (one case) were absolute indications for surgery, as were bowel wall or mesenteric hematomas accompanied by substantial amounts of intraperitoneal fluid. The patient's history, physical examination, and initial laboratory values are important in proper selection of patients for CT evaluation. We feel that CT appears to offer certain definite advantages over peritoneal lavage in evaluation of bowel and mesenteric injuries and can reliably help to distinguish the injuries that require surgical repair from those that can be safely monitored and observed.
在1980年至1984年的5年期间，对24例计算机断层扫描（CT）显示有肠系膜或肠道损伤迹象的患者进行了治疗。所有患者均为腹部钝性创伤的受害者。9例有肠系膜或肠血肿CT证据的患者接受了观察，未出现不良后果。15例患者接受了手术探查，其中14例的损伤与术前CT扫描结果相似。在接受手术的患者组中，除1例患者外，其余患者均存在肠壁增厚或腹腔内游离液体（血液或密度较低的液体）或两者皆有。肠腔外气体（3例）或泛影葡胺（施贵宝公司生产）（1例）是手术的绝对指征，伴有大量腹腔内液体的肠壁或肠系膜血肿也是手术指征。患者的病史、体格检查和初始实验室值对于正确选择进行CT评估的患者很重要。我们认为，在评估肠道和肠系膜损伤方面，CT似乎比腹腔灌洗具有某些明确的优势，并且能够可靠地帮助区分需要手术修复的损伤与可以安全监测和观察的损伤。
