Patel V G, Walker M L
Department of Surgery, Morehouse School of Medicine and Grady Memorial Hospital, Atlanta, Georgia 30335, USA.
Am Surg. 1997 Apr;63(4):350-3.
The role of limited "one-shot" intravenous pyelogram (IVP) in patients sustaining proximity penetrating trauma is not well defined, although formal IVP remains the "gold standard" for evaluating possible urological injuries. This retrospective review evaluates the efficacy and usefulness of limited one-shot IVP in penetrating abdominal trauma patients who are suspected of having urological injuries. The charts of 40 patients with penetrating abdominal trauma who had one-shot IVP performed in the emergency room at presentation were reviewed. Of the total, 36 patients had gunshot wounds and only 4 patients had stab wounds. Mean Penetrating Abdominal Trauma Index was 15.7, with 47.5 per cent of patients in shock. Only 2 out of 10 urological injuries were detected by one-shot IVP. The positive predictive value of limited one-shot IVP was only 20 per cent, with sensitivity 25 per cent and specificity 76.2 per cent. The results of the one-shot IVP did not influence the decisions for laparotomy in any of the 35 (87.5%) patients who underwent exploratory laparotomy. In the two patients with positive one-shot IVPs who had urological injuries, the decision to operate was again determined by the presence of other associated intra-abdominal injuries. Eighty per cent of patients with normal one-shot IVP findings had renal injuries not detected by one-shot IVP, and 20 per cent of patients with abnormal IVP findings had no intraoperative evidence of renal injury. The presence of gross hematuria appeared to correlate with the presence of significant urological injuries. We therefore conclude that limited one-shot IVP is of no significant value in assessing penetrating abdominal trauma patients who subsequently undergo exploratory laparotomy for other associated intra-abdominal injuries, and indeed, the delay imposed, before definitive operative intervention in potentially unstable patients, is unjustified.
尽管传统静脉肾盂造影（IVP）仍是评估可能存在的泌尿系统损伤的“金标准”，但有限的“单次”静脉肾盂造影在遭受近距离穿透伤患者中的作用尚未明确界定。本回顾性研究评估了有限单次静脉肾盂造影在怀疑有泌尿系统损伤的穿透性腹部创伤患者中的有效性和实用性。回顾了40例在急诊室就诊时接受单次静脉肾盂造影的穿透性腹部创伤患者的病历。其中，36例患者为枪伤，仅4例患者为刺伤。平均穿透性腹部创伤指数为15.7，47.5%的患者处于休克状态。单次静脉肾盂造影仅检测出10例泌尿系统损伤中的2例。有限单次静脉肾盂造影的阳性预测值仅为20%，敏感性为25%，特异性为76.2%。单次静脉肾盂造影的结果并未影响35例（87.5%）接受剖腹探查术患者的剖腹决策。在2例单次静脉肾盂造影阳性且有泌尿系统损伤的患者中，手术决策同样由其他相关腹腔内损伤的存在决定。单次静脉肾盂造影结果正常的患者中，80%存在单次静脉肾盂造影未检测到的肾损伤；单次静脉肾盂造影结果异常的患者中，20%术中无肾损伤证据。肉眼血尿的出现似乎与严重泌尿系统损伤的存在相关。因此，我们得出结论，有限单次静脉肾盂造影在评估因其他相关腹腔内损伤而随后接受剖腹探查术的穿透性腹部创伤患者时无显著价值，实际上，在可能不稳定的患者中，在确定性手术干预之前造成的延迟是不合理的。
