Ahmad Zohaib Y, McDonald Julian M N, Baghdanian Armonde A, Anderson Stephan W, LeBedis Christina A
Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America.
Department of Radiology, Boston Medical Center, Boston, MA, United States of America.
Emerg Radiol. 2024 Dec;31(6):797-805. doi: 10.1007/s10140-024-02287-1. Epub 2024 Oct 15.
Damage Control Surgery (DCS) refers to a staged laparotomy performed in patients who have suffered severe blunt or penetrating abdominopelvic trauma with the goal of managing critical injuries while avoiding life threatening metabolic derangements. Within 24 h of the initial laparotomy, computed tomography (CT) is used to assess the full extent of injuries. The purpose of this study was to assess the incidence of clinically significant unknown abdominopelvic injuries which required further dedicated surgical or interventional radiology management and failed surgical repairs identified on CT following initial laparotomy.
CT findings were correlated with surgical findings from the initial and subsequent staged laparotomy to determine known and unknown injuries. Frequency and percentage analyses was performed.
Out of 63 patients who underwent DCS with an open abdomen following initial laparotomy and subsequent CT within 24 h, a total of 13 clinically significant abdominopelvic injuries were identified in 12 patients. Seven clinically significant injuries were identified in seven patients (11.1% of patients) in surgically explored areas. Six clinically significant injuries were identified in six patients (9.5%) in surgically unexplored areas. Four instances of failed initial surgical repair were identified in four patients (6.3%) involving the liver and gastrointestinal tract. Overall, 23.8% of the DCS patient population had an actionable finding on the post laparotomy CT.
CT demonstrated value for identifying the extent of clinically significant abdominopelvic injuries and evidence of failed initial surgical repair, which informed surgical planning for subsequent laparotomy. The authors advocate for performing CT in post-DCS patients with an open abdomen as soon as possible following correction of metabolic and hemodynamic derangements.
损伤控制手术（DCS）是指对遭受严重钝性或穿透性腹部盆腔创伤的患者进行的分期剖腹手术，其目的是处理严重损伤，同时避免危及生命的代谢紊乱。在初次剖腹手术后24小时内，使用计算机断层扫描（CT）评估损伤的全部范围。本研究的目的是评估临床上有意义的不明腹部盆腔损伤的发生率，这些损伤需要进一步专门的手术或介入放射学处理，以及初次剖腹手术后CT上发现的手术修复失败情况。
将CT检查结果与初次及后续分期剖腹手术的手术结果进行关联，以确定已知和未知的损伤情况。进行频率和百分比分析。
在63例初次剖腹手术后行DCS且术后24小时内进行CT检查的患者中，12例患者共发现13处临床上有意义的腹部盆腔损伤。在手术探查区域的7例患者中发现了7处临床上有意义的损伤（占患者的11.1%）。在未进行手术探查区域的6例患者中发现了6处临床上有意义的损伤（占9.5%）。4例患者（占6.3%）出现初次手术修复失败，涉及肝脏和胃肠道。总体而言，23.8%的DCS患者在剖腹手术后的CT检查中有可采取行动的发现。
CT在确定临床上有意义的腹部盆腔损伤范围及初次手术修复失败证据方面显示出价值，这为后续剖腹手术的手术规划提供了依据。作者主张在代谢和血流动力学紊乱得到纠正后，尽快对腹部开放的DCS术后患者进行CT检查。
