Brick S H, Taylor G A, Potter B M, Eichelberger M R
Department of Radiology, Children's Hospital National Medical Center, Washington, D.C. 20010.
Radiology. 1987 Dec;165(3):643-6. doi: 10.1148/radiology.165.3.3685344.
Clinical and radiographic records of 274 children who were examined with abdominal computed tomography (CT) after blunt abdominal trauma were retrospectively evaluated to test the hypothesis that CT can assist in decisions to perform laparotomy in children with hepatic or splenic injury. CT demonstrated parenchymal injuries in 36 patients (13%) or 20 livers and 21 spleens. Injury to these organs was categorized as minor (39%), moderate (39%), and severe (21%) according to an assessment of the percentage of parenchymal involvement. Hemoperitoneum was detected in 27 of 36 patients (75%). One of 13 (4.7%) with a moderate to large splenic injury underwent splenorrhaphy because of persistent bleeding. One of 12 (5%) with a moderate to large hepatic injury required late operative intervention due to a large necrotic segment. Both children had a large amount of peritoneal fluid. Two of 16 patients (13%) with moderate to large hemoperitoneum required surgery for liver or splenic injury. The decision for laparotomy should not be based on the extent of injury as shown at CT but on the physiologic condition of the child.
对274名腹部钝性创伤后接受腹部计算机断层扫描（CT）检查的儿童的临床和影像学记录进行回顾性评估，以检验CT可协助决定对肝或脾损伤儿童进行剖腹手术这一假设。CT显示36例患者（13%）存在实质损伤，即20个肝脏和21个脾脏受损。根据实质受累百分比评估，这些器官的损伤分为轻度（39%）、中度（39%）和重度（21%）。36例患者中有27例（75%）检测到腹腔积血。13例中至大量脾损伤患者中有1例（4.7%）因持续出血接受了脾修补术。12例中至大量肝损伤患者中有1例（5%）因大片坏死区域需要后期手术干预。两名儿童均有大量腹腔积液。16例中至大量腹腔积血患者中有2例（13%）因肝或脾损伤需要手术。剖腹手术的决定不应基于CT所示的损伤程度，而应基于儿童的生理状况。
