Méndez Gallart R, Gómez Tellado M, Ríos Tallón J, Dargallo Carbonell T, Ramil Fraga C, Candal Alonso J
Servicio de Cuidados Intensivos Pediátricos, Hospital Materno-Infantil Teresa Herrera, La Coruña.
Cir Pediatr. 1996 Apr;9(2):60-3.
During the 7 year period, 1987 to 1994, 48 patients with blunt abdominal trauma were treated in our Hospital. There were splenic injury in 50% cases, liver trauma in 25% and renal injury in 40%. Seven patients suffered injuries to multiple sites. The clinical findings were confirm with ultrasound (47 children) and Computed Tomography scanning (CT) (19 children). Intravenous pyelography were performed in nine cases with previously suspect of renal affection. The CT scan provided diagnosis in four patients with negative findings in the sonography. In the present serine, 42 cases were managed by nonoperative means with 100% survivals. One patient surgically treated died from associated severe head injury. The postoperative complications appeared in ten nonoperatively cases (recurrence of bleeding in four children). 14 of these non surgical patients required blood transfusion, and the mean volume of transfusion was 30 ml/kg. A follow-up abdominal sonography was obtained in all survivors, showing resolution of the injury in all of them. We conclude that non surgical managements must be the first choice in all blunt abdominal trauma in pediatrics. Laparotomy is mandatory in masive bleeding or hemodynamically inestable patients. Ultrasonography is a simple method without risks and fast available, well indicated for diagnosis and follow-up of this children.
在1987年至1994年的7年期间，我院共收治48例钝性腹部创伤患者。其中50%为脾损伤，25%为肝损伤，40%为肾损伤。7例患者为多处受伤。临床诊断通过超声检查（47例儿童）和计算机断层扫描（CT）（19例儿童）得以证实。9例曾怀疑有肾脏病变的患者进行了静脉肾盂造影。CT扫描为4例超声检查结果阴性的患者提供了诊断依据。在本系列研究中，42例采用非手术治疗，全部存活。1例接受手术治疗的患者因合并严重颅脑损伤死亡。10例非手术治疗的患者出现了术后并发症（4例儿童出血复发）。这些非手术治疗的患者中有14例需要输血，平均输血量为30 ml/kg。所有幸存者均接受了腹部超声随访，结果显示损伤均已恢复。我们得出结论，非手术治疗必须是小儿钝性腹部创伤的首选治疗方法。对于大出血或血流动力学不稳定的患者，必须进行剖腹手术。超声检查是一种简单、无风险且可快速获得的方法，非常适合用于此类儿童的诊断和随访。
