Free fluid on abdominal computed tomography without solid organ injury after blunt abdominal injury does not mandate celiotomy
Free fluid on abdominal computed tomography without solid organ injury after blunt abdominal injury does not mandate celiotomy
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DOI：
10.1016/s0002-9610(01)00665-1
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发表时间：
2001-07-01
影响因子：
3
通讯作者：
Malangoni, MA
中科院分区：
文献类型：
--
作者：
Livingston, DH;Lavery, RF;Malangoni, MA
背景：对于腹部钝性损伤后腹部计算机断层扫描（CT）显示有不明原因游离液体的所有患者，已有人提议进行强制性剖腹手术。这一建议是基于回顾性数据以及对肠道钝性损伤延迟诊断可能导致的发病率的担忧。本研究检查了腹部钝性创伤后腹部CT显示有游离液体的患者的肠道损伤发生率。
方法：本研究是一项多中心前瞻性系列研究，涉及在22个月期间被四家一级创伤中心收治的所有腹部钝性创伤患者。在患者入组时同时收集数据，包括人口统计学资料、损伤严重程度评分、CT扫描结果以及是否存在肠道钝性损伤。专门对那些有游离液体但无实质器官损伤的患者查询了该数据库。
结果：总共对2299名患者进行了评估。265名患者存在游离液体。其中，90名患者仅有游离液体，仅有7名患者有肠道钝性损伤。相反，91%有游离液体的患者没有肠道损伤。对所有有游离液体的患者平均观察8天（95%置信区间为6.1至10.4天，范围为1至131天）。没有漏诊的情况。
结论：腹部CT扫描显示有游离液体并不一定需要进行剖腹手术。建议进行系列观察，并可能使用其他辅助检查。（C）2001爱思唯尔出版公司。保留所有权利。
Background: Mandatory celiotomy has been proposed for all patients with unexplained free fluid on abdominal computed tomography (CT) scanning after blunt abdominal injury. This recommendation has been based upon retrospective data and concerns over the potential morbidity from the late diagnosis of blunt intestinal injury. This study examined the rate of intestinal injury in patients with free fluid on abdominal CT after blunt abdominal trauma.Methods: This study was a multicenter prospective series of all patients with blunt abdominal trauma admitted to four level I trauma centers over 22 months. Data were collected concurrently at the time of patient enrollment and included demographics, injury severity score, findings on CT scan, and presence or absence of blunt intestinal injury. This database was specifically queried for those patients who had free fluid without solid organ injury.Results: In all, 2,299 patients were evaluated. Free fluid was present in 265. Of these, 90 patients had isolated free fluid with only 7 having a blunt intestinal injury. Conversely, 91% of patients with free fluid did not. All patients with free fluid were observed for a mean of 8 days (95% confidence interval 6.1 to 10.4, range 1 to 131). There were no missed injuries.Conclusions: Free fluid on abdominal CT scan does not mandate celiotomy. Serial observation with the possible use of other adjunctive tests is recommended. (C) 2001 Excerpta Medica, Inc. All rights reserved.