rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2021-102-1-57-65rentrad-613Research ArticleОБЗОРЫREVIEWSТактика первичной экстренной лучевой диагностики политравмыTactics of Primary Emergency Radiation Diagnosis of Politraumahttps://orcid.org/0000-0003-0186-1892ШапкинЮ. Г.ShapkinYu. G.

Шапкин Юрий Григорьевич, д. м. н., профессор, заведующий кафедрой общей хирургии

ул. Большая Казачья, 112, Саратов, 410012

Yuriy G. Shapkin, Dr. Med. Sc., Professor, Chief of Chair of General Surgery

ul. Bolshaya Kazachya, 112, Saratov, 410012

https://orcid.org/0000-0002-3416-0470СеливерстовП. А.SeliverstovP. A.

Селиверстов Павел Андреевич, к. м. н., ассистент кафедры общей хирургии

ул. Большая Казачья, 112, Саратов, 410012

Pavel А. Seliverstov, Cand. Med. Sc., Assistant Professor, Chair of General Surgery

ul. Bolshaya Kazachya, 112, Saratov, 410012

seliwerstov.pl@yandex.ruhttps://orcid.org/0000-0002-1407-8744СтекольниковН. Ю.StekolnikovN. Yu.

Стекольников Николай Юрьевич, к. м. н., доцент кафедры общей хирургии

ул. Большая Казачья, 112, Саратов, 410012

Nikolay Yu. Stekolnikov, Cand. Med. Sc., Associate Professor, Chair of General Surgery

ul. Bolshaya Kazachya, 112, Saratov, 410012

ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава РоссииРоссияRazumovskiy Saratov State Medical UniversityRussian Federation20211003202110215765Copyright © Шапкин Ю.Г., Селиверстов П.А., Стекольников Н.Ю., 20212021Шапкин Ю.Г., Селиверстов П.А., Стекольников Н.Ю.Shapkin Y.G., Seliverstov P.A., Stekolnikov N.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/613

В обзоре рассмотрена проблема выбора оптимального тактического подхода к первичной экстренной лучевой диагностике повреждений при политравме на основе данных о показаниях к применению, преимуществах и недостатках современных методов и протоколов лучевой визуализации. Проведен поиск литературных источников в базах данных MedLine/PubMed и eLibrary, опубликованных в период с 2009 по 2019 г.

Тактика целенаправленной лучевой диагностики политравмы подразумевает выполнение последовательных исследований (ультразвуковых, рентгенографических, компьютерной томографии) областей тела, в которых по механизму травмы и клиническим данным подозреваются повреждения, что ограничивает точность диагностики и увеличивает продолжительность обследования. Первичная мультиспиральная компьютерная томография «всего тела», включающая исследование головы, шеи, груди, живота и таза, снижает долю пропущенных повреждений, сокращает продолжительность обследования и время до начала экстренных хирургических вмешательств, за счет чего может значимо снизить летальность при политравме. Ее применение оправданно у пациентов с тяжелой сочетанной травмой при условии высокого уровня организации неотложной госпитальной помощи. Использование компьютерной томографии «всего тела» значительно увеличивает дозу облучения и экономические затраты, но польза от нее с точки зрения выживаемости пациентов с политравмой может перевесить радиационный риск и экономические потери. Дальнейшее развитие технологий и протоколов мультиспиральной компьютерной томографии способно значительно уменьшить дозу облучения и длительность исследования. Необходимы четкие и обоснованные критерии отбора пациентов, у которых применение компьютерной томографии «всего тела» будет эффективной стратегией лучевой диагностики.

The review considers the problem of choosing the optimal tactical approach to primary emergency radiation diagnosis of injuries during polytrauma based on data on indications for use, advantages and disadvantages of modern methods and protocols of radiation imaging. Literary sources were searched in the MedLine/ PubMed and eLibrary databases published from 2009 to 2019.

The tactics of selective radiation diagnosis of polytrauma involves performing sequential studies (sonography, X-ray, computed tomography) of body areas in which damage is suspected by the mechanism of injury and clinical data, which limits the accuracy of the diagnosis and increases the duration of the examination. Primary multi-helical “whole-body”computed tomography including head, neck, chest, abdomen and pelvis examination, reduces the percentage of missed injuries, the duration of the examination and the time before emergency surgery, which can significantly reduce mortality in polytrauma. Its use is justified in patients with severe combined trauma if a high level of emergency hospital care organization is provided. Using “whole-body” computed tomography significantly increases the dose and economic costs, but the benefits of it for the survival of patients with polytrauma can outweigh the radiation risk and economic losses. Further development of technologies and protocols for multispiral computed tomography can significantly reduce the dose of radiation and the duration of the study. Clear and well-founded criteria for the selection of patients are needed for whom the use of “whole-body” computed tomography will be an effective strategy for radiation diagnosis.

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The authors declare that there are no conflicts of interest present.