간 손상시 시행한 복부 단층 촬영의 의의 = Significance of Abdominal Computed Tompgraphy in Blunt Hepatic Injury

다국어 초록 (Multilingual Abstract)

Surgery is recognized as normal treatment method for liver injuries. However, as the C-T scan is more widely used in cases of blunt abdominal trauma, approximately 20 to 30% of liver injuries are now being treated by means other than surgery. Although generally excellent as a tool for diagnosis of blunt abdominal trauma, C-T scan is still subject to controversy regarding its accuracy. It is true that abdominal C-T scan is valuable particularly for prognosis of the individual damages of solid organs such as liver, however the indications produced by C-T scan are sometimes inconsistent with surgery results or clinically observed symptoms. The purpose of this paper is to suggest guidelines for prognosis of liver injuries resulting from blunt abdominal trauma by analyzing the discrepancy between the surgery findings and the indications shown by C-T scan. For evaluation of this differences, we examined our experience with blunt hepatic trauma patients over the last 5 years. 51 patients who evaluated by cornputed tomography were reviewed. Among them, 19 patients were controlled by nonoperative method but 32 patients required operative management. The mean age was 33. 1 and 66. 7% were male. With using Injury Severity Scale of American Association for the Surgery of Trauma (AAST), 21 were Grade II (41. 2%), 12 were Grad III (23. 5%), 10 were Grade I (19.6%). All nonoperative management group revealed below the Grade K. In 32 patients of operative management group, 20 were below the Grade E. In 20 patients, 7(35.0%) were operatecl due to associated injuries and 13 (65. 0%) were operated due to unstable vital sign and increasing blood transfusion requirement. On the comparison between computed tomographic and operative findings, 10(31. 3%) were corresponding to operative findings, 19(59. 4%) were underestimated and 3(9.4%) were overestimated. 11(58.9%) of underestimated patients showed only one-grade difference, but 4(21.1%) and 4(21.1%) showed two and three-grade differences respectively. In cases where severe damages were found through surgery, the amount of blood transfusion actually required was cosiderably larger than indicated by C-T scan. C-T scan was quite helpful in making the dicision as to perform the surgery or not; however, C-T scan tended to underestimate the degree of liver damages; in particular, C-T scan was not accurate in predicting the requisite amount of blood transfusion. Consequently, we concluded that (1) it is not safe to determine the treatment methods for liver injuries solely on the basis of C-T scan and (2) it is urgently needed to develop a grading system where by C-T scan results can be appropriately evaluated. In addition it may be desirable to use C-T scan together with other types of diagnostic methods.