Canarelli J P, Ricard Y, Collet L M, Legraverend J M
J Chir (Paris). 1986 May;123(5):362-5.
Marked progress in the treatment of abdominal contusions in children over the last few years is due to the development of conservative surgery to the spleen and even possible abstention from operation following splenic injuries. The reliability of paraclinical exploratory procedures has increased, and ultrasound and CT scan imaging have reduced the need for peritoneal puncture-lavage. However, and unresolved problem concerns associated visceral lesions, and although treatment of isolated splenic injuries is fairly well detailed that of hepatic lesions raises difficulties because of lack of data on exact location of lesions and the anatomical damage produced. Injuries provoked and treatment instituted are described in relation to children admitted for severe abdominal contusions between 1970 and 1985. Since 1984, 52 children have undergone initial ultrasound imaging and only 6 (8%) peritoneal puncture-lavage procedures were necessary. Ultrasound is of value for diagnosis of a hemoperitoneum but of very limited use for defining sites of lesions, a more refined diagnosis being established by computed tomography. Finally, routine simplified emergency intravenous urography is performed in any child with severe abdominal contusion with even microscopic hematuria to detect possible subadventitial rupture of renal artery.
在过去几年中，儿童腹部挫伤的治疗取得了显著进展，这得益于脾脏保守手术的发展，甚至在脾损伤后有可能避免手术。临床辅助检查方法的可靠性有所提高，超声和CT扫描成像减少了腹腔穿刺灌洗的需求。然而，一个尚未解决的问题涉及相关的内脏损伤，尽管孤立性脾损伤的治疗方法已有相当详细的描述，但由于缺乏关于损伤确切位置和所产生的解剖损伤的数据，肝损伤的治疗仍存在困难。本文描述了1970年至1985年间因严重腹部挫伤入院的儿童所遭受的损伤及采取的治疗措施。自1984年以来，52名儿童接受了初步超声检查，仅6例（8%）需要进行腹腔穿刺灌洗。超声对诊断腹腔积血有价值，但在确定损伤部位方面作用非常有限，通过计算机断层扫描可做出更精确的诊断。最后，对任何有严重腹部挫伤甚至镜下血尿的儿童进行常规简化急诊静脉肾盂造影，以检测可能的肾动脉外膜下破裂。
