Frola C, Casiglia M, Cantoni S, Loria F, Leoni C
IV Divisione di Radiologia, Ospedale San Martino, Genova.
Radiol Med. 1993 Dec;86(6):833-40.
In this paper the authors try to define CT criteria for the evaluation of hepatic and splenic injuries in blunt abdominal traumas, to suggest and guide the nonoperative management of trauma in hemodynamically stable patients. The predictive value of CT on the outcome of the nonoperative treatment in adult patients with blunt hepatic and splenic trauma is trusted more and more also thanks to the good results of conservative management in similar injuries in pediatric patients. Thus, we reviewed 314 emergency abdominal CT scans performed in our center March 1990 to March 1992. The hepatic and splenic injuries detected on CT scans were evaluated according to a CT-based injury classification in grades, with a score reflecting progressive severity of lesions. Moreover, the presence of intraperitoneal hemorrhage was determined and quantified on the basis of a standard classification system. Of 314 cases, CT revealed blunt hepatic injury in 17 patients and blunt splenic injury in 38. We excluded the patients who exhibited, besides the hepatic or splenic injury, other severe visceral lesions which might need surgery. Nonoperative management was attempted in 9 of 17 patients with hepatic injury and in 4 of 38 patients with splenic injury detected by CT; the scores given according to the above classification system were compared with the clinical outcome. The results indicate that hepatic injuries up to and including grade III, as assessed by CT, can be successfully managed without surgery in hemodynamically stable patients. As for splenic traumas, nonoperative management was attempted in a very small number of patients. Even though a case of grade-III splenic injury in our series was successfully treated without surgery, this may not be the rule, because the outcome of splenic injury and of intraperitoneal hemorrhage is often unpredictable.
在本文中，作者试图定义CT标准，用于评估钝性腹部创伤中的肝脾损伤，以建议并指导血流动力学稳定患者创伤的非手术治疗。由于小儿患者类似损伤保守治疗取得良好效果，CT对成人钝性肝脾创伤非手术治疗结果的预测价值也越来越受到信赖。因此，我们回顾了1990年3月至1992年3月在本中心进行的314例急诊腹部CT扫描。根据基于CT的损伤分级对CT扫描检测到的肝脾损伤进行评估，评分反映病变的严重程度。此外，根据标准分类系统确定并量化腹腔内出血的存在情况。在314例病例中，CT显示17例钝性肝损伤和38例钝性脾损伤。我们排除了除肝或脾损伤外还存在可能需要手术的其他严重内脏损伤的患者。对CT检测到的17例肝损伤患者中的9例和38例脾损伤患者中的4例尝试进行非手术治疗；将根据上述分类系统给出的评分与临床结果进行比较。结果表明，对于血流动力学稳定的患者，CT评估为III级及以下的肝损伤可以成功地进行非手术治疗。至于脾创伤，仅对极少数患者尝试进行非手术治疗。尽管我们系列中有一例III级脾损伤成功接受了非手术治疗，但这可能并非普遍规律，因为脾损伤和腹腔内出血的结果往往不可预测。
