CT在外伤性急腹症诊断定位中的价值

CT in diagnosing and predicting site of traumatic acute abdomen

目的探讨外伤性急腹症的CT征象,提高CT对腹腔脏器损伤的诊断价值。方法回顾性分析经手术证实为腹腔脏器损伤的186例患者的术前CT图像,总结不同脏器损伤的CT表现特征。结果 186例中共有271处脏器损伤,其中实质脏器损伤228处,空腔脏器损伤43处。腹腔出现腹水的有157例(84.4%),腹腔出现血肿的有65例(34.9%)。实质性脏器损伤CT主要表现为损伤处出现混杂密度影(71.9%),包膜或边界不光整(59.2%),包膜下积血或血肿形成(56.6%)和周围筋膜增厚或脂肪间隙模糊(78.9%)。空腔脏器损伤主要表现为损伤处结构紊乱(62.8%)或壁增厚(72.1%),腔内可出现血肿(20.9%)。结论不同的腹腔脏器损伤具有不同的CT表现,外伤性急腹症的诊断和定位需要结合外伤原因、临床表现和CT征象。

Objective To summarize CT signs of traumatic acute abdomen, and to assess clinical value of CT in diagnosing organ injury in the abdomen. Methods A retrospective analysis of 186 cases was performed and preoperative CT images were analyzed after intraoperative confirmation of abdominal organ injury. Therefore, CT features of different organ injuries were summarized. Results 271 organ injuries were found in 186 patients, including 228 injuries involving parenchyma organs and 43 injuries involving hollow viseeras. Abdominal ascites was found in 157 patients （ 84.4% ） and abdominal hematoma in 65 patients （ 34.9% ）. CT manifestations of parenchyma injury were mixed density （71.9%） in damaging location, with incomplete capsule or border （59. 2% ）, subcapsular hematoma （56. 6% ） and fascia thickening surrounding or fat fuzzy space （ 78.9% ）. CT manifestations of hollow visceral injury were structure disorders （62.8%） or wall thickening （72.1% ）, hematoma in cavity （20.9%）. Conclusion There are different CT manifestations in different organ injuries, and the diagnosis and predicting site of traumatic acute abdomen require the combination of injury causes, clinical manifestations and CT findings.