Gilliland M G, Ward R E, Flynn T C, Miller P W, Ben-Menachem Y, Duke J H
Am J Surg. 1982 Dec;144(6):744-7. doi: 10.1016/0002-9610(82)90562-1.
One hundred consecutive patients with pelvic fractures who had undergone peritoneal lavage and abdominal and pelvic angiography were retrospectively analyzed. Sixty-four patients with negative lavages were treated successfully without laparotomy despite a 20 percent incidence of subcapsular or intraparenchymal hematomas of the liver or spleen. Thirty percent of the patients with positive peritoneal lavages were successfully managed without laparotomy when abdominal angiography failed to identify a source of active bleeding. Abdominal angiography was 92 percent accurate in predicting the presence or absence of hemorrhage in 25 patients who underwent laparotomy. There were no false-positive angiograms. The overall false-negative rate was 2.12 percent. These occurred in two patients with torn mesenteric vessels. Pelvic angiography identified arterial pelvic bleeding in 18 percent of the patients. Eighty-four percent of patients with major pelvic bleeding had successful embolization with prompt cessation of arterial bleeding. We conclude that abdominal and pelvic angiography can be a useful adjunct to peritoneal lavage in detecting intraperitoneal hemorrhage and can be of therapeutic value for arterial pelvic bleeding.
对连续100例接受了腹腔灌洗以及腹部和盆腔血管造影的骨盆骨折患者进行了回顾性分析。64例灌洗结果为阴性的患者，尽管有20%的患者出现肝或脾包膜下或实质内血肿，但未行剖腹手术而成功治愈。当腹部血管造影未能确定活动性出血来源时，30%灌洗结果为阳性的患者未行剖腹手术而成功处理。在25例接受剖腹手术的患者中，腹部血管造影预测出血存在与否的准确率为92%。没有血管造影假阳性情况。总体假阴性率为2.12%。这发生在2例肠系膜血管撕裂的患者中。盆腔血管造影在18%的患者中发现盆腔动脉出血。84%有严重盆腔出血的患者成功进行了栓塞，动脉出血迅速停止。我们得出结论，腹部和盆腔血管造影在检测腹腔内出血方面可作为腹腔灌洗的有用辅助手段，并且对盆腔动脉出血具有治疗价值。
