Yokota J, Sugimoto T
Department of Traumatology, Osaka University Medical School, Japan.
Am J Surg. 1994 Sep;168(3):247-50. doi: 10.1016/s0002-9610(05)80196-5.
This study was undertaken to evaluate the clinical significance of periportal tracking on computed tomography (CT) in patients with blunt liver trauma. The clinical records and CT findings of 88 patients were reviewed. Angiographic study revealed potential injury to portal triads in patients with periportal tracking on CT. Extrahepatic injuries beneath the liver were associated in 22 of 28 patients with periportal tracking and in 2 of 17 without periportal tracking (P < 0.01, chi-square = 16.38). Hepatic complications such as bile leak, biloma, hemobilia, and infected hematoma were evaluated separately in 43 patients treated conservatively and 45 patients treated surgically. The incidence of complications in patients with periportal tracking was significantly higher in both groups (nonoperative; P < 0.01, chi-square = 8.46 and operative; P < 0.01, chi-square = 8.48). We conclude that periportal tracking on CT implies injury to the subhepatic region and intrahepatic portal triads and that it requires careful examination for extrahepatic injuries in the initial management and late hepatic complications in the follow-up management.
本研究旨在评估钝性肝外伤患者计算机断层扫描（CT）上的肝门周围追踪的临床意义。回顾了88例患者的临床记录和CT表现。血管造影研究显示，CT上有肝门周围追踪的患者门静脉三联可能受损。28例有肝门周围追踪的患者中有22例合并肝下的肝外损伤，17例无肝门周围追踪的患者中有2例合并肝外损伤（P<0.01，卡方=16.38）。分别对43例保守治疗患者和45例手术治疗患者的肝并发症如胆漏、胆汁瘤、胆道出血和感染性血肿进行了评估。两组中有肝门周围追踪的患者并发症发生率均显著更高（非手术治疗组；P<0.01，卡方=8.46；手术治疗组；P<0.01，卡方=8.48）。我们得出结论，CT上的肝门周围追踪提示肝下区域和肝内门静脉三联受损，在初始处理中需要仔细检查肝外损伤，在随访处理中需要关注后期肝并发症。
