Allins A, Ho T, Nguyen T H, Cohen M, Waxman K, Hiatt J R
Department of Surgery, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Am Surg. 1996 Nov;62(11):883-6.
The objective was to determine the utility of a second CT scan in nonoperative management of blunt liver and splenic trauma. The design was a retrospective review of consecutive cases over a 2-year period in two trauma centers. Subjects were 152 patients with blunt abdominal trauma and isolated injuries to liver and/or spleen. Thirty patients received immediate laparotomy, whereas 122 patients (80%) underwent CT scanning that showed splenic (n = 64), liver (n = 44), or combined (n = 14) injuries. Nonoperative management was undertaken in 99 of the 122 (81% of the patients who received CT scans; 65% of the overall series) and was ultimately successful in 94 (95%). Second CT scans were used in 26 patients (26%), one of whom received laparotomy for drainage of a bile leak and three for ongoing bleeding. None of the followup scans showed major progression of injury, and scan findings did not influence decisions for operation in any patients. Routine followup CT scanning is not a justifiable component of nonoperative management protocols for blunt liver and splenic injuries.
目的是确定第二次CT扫描在钝性肝脾创伤非手术治疗中的作用。研究设计为对两个创伤中心2年期间的连续病例进行回顾性分析。研究对象为152例钝性腹部创伤且肝脏和/或脾脏单独受伤的患者。30例患者立即接受剖腹手术，而122例患者（80%）接受了CT扫描，结果显示脾脏损伤（n = 64）、肝脏损伤（n = 44）或两者合并损伤（n = 14）。122例患者中的99例（接受CT扫描患者的81%；整个系列的65%）采取了非手术治疗，最终94例（95%）成功。26例患者（26%）进行了第二次CT扫描，其中1例因胆汁漏引流接受剖腹手术，3例因持续出血接受手术。所有后续扫描均未显示损伤有重大进展，扫描结果也未影响任何患者的手术决策。对于钝性肝脾损伤的非手术治疗方案，常规的随访CT扫描并非合理组成部分。
