Meyer A A, Crass R A, Lim R C, Jeffrey R B, Federle M P, Trunkey D D
Arch Surg. 1985 May;120(5):550-4. doi: 10.1001/archsurg.1985.01390290032005.
Computed tomographic (CT) scans are used to evaluate victims of blunt trauma for abdominal injury when reasons for immediate laparotomy are not present. Twenty-four patients whose CT scans showed liver injuries that were small parenchymal lacerations or intrahepatic hematomas were managed without laparotomy. Intra-abdominal blood was absent or estimated to be less than 250 mL in volume. None of the patients were in shock; six patients required transfusions, none for acute abdominal bleeding. None of these patients subsequently required laparotomy or showed hepatobiliary problems at a follow-up examination less than one year later. Five follow-up scans showed varying degrees of resolution. Two patients died of severe head injury, but the liver injury did not contribute to the cause of death. Other patients with more severe blunt liver injury who were treated nonoperatively developed significant complications that required delayed surgery. It seems that patients with limited liver injury diagnosed by CT scan and selected by strictly applied criteria can be managed safely without laparotomy in a setting where rapid evaluation and treatment of any potential complication is available.
当不存在立即进行剖腹手术的指征时，计算机断层扫描（CT）用于评估钝性创伤患者是否存在腹部损伤。24例CT扫描显示肝脏损伤为小实质撕裂伤或肝内血肿的患者未接受剖腹手术治疗。腹腔内无血液或估计血量少于250毫升。所有患者均未休克；6例患者需要输血，均非因急性腹腔出血。这些患者随后均未进行剖腹手术，且在不到一年后的随访检查中均未出现肝胆问题。5次随访扫描显示损伤有不同程度的消退。2例患者死于严重颅脑损伤，但肝脏损伤并非死因。其他接受非手术治疗的严重钝性肝损伤患者出现了需要延迟手术的严重并发症。在能够对任何潜在并发症进行快速评估和治疗的情况下，经CT扫描诊断且符合严格标准的肝脏损伤有限的患者似乎可以安全地不进行剖腹手术治疗。
