超声造影评价闭合性脾损伤的实验研究

Contrast-enhanced ultrasonography for evaluation of spleen injury in blunt abdominal trauma

目的探讨超声造影评价闭合性脾损伤的价值。方法20只健康杂种犬,随机分为两组,每组10只,其中一组全身肝素化处理,另一组不进行肝素化处理,采用自制小型撞击器撞击犬体表脾区,建立闭合性脾损伤模型。分别于撞击前、撞击后对脾进行普通二维超声和超声造影检查,实验结束后评估脾损伤情况并与上述检查结果进行对照研究。结果普通二维声像图:脾实质损伤区回声不规则,与正常脾组织界限不清晰,部分可见包膜连续性中断,包膜下及腹腔可见不同程度的积液。超声造影所见:脾实质损伤伴活动性出血时在不同时相的增强特点不同;脾包膜破裂伴活动性出血时,可见微气泡自破裂口向外呈“涌泉状”或“喷射状”移动;脾内血肿形成而止血时,血肿内各时相均未见增强效应。病理检查结果与超声造影结果相关性好。结论超声造影能通过微气泡的增强特征实时判断脾是否存在活动性出血或形成血肿。

Objective To evaluate contrast-enhanced ultrasonography（CEUS） for diagnosing spleen injury in blunt abdominal trauma. Methods Twenty dogs were randomly divided into two groups and each group included 10 dogs. The dogs were heparinized in one group and the other group was not heparinized. Self-made miniature impactor was used to impact these dogs to make models of blunt splenic trauma. Conventional two- dimensional ultrasonography and CEUS were used to detect local echo changes of the spleens before and after impacting. After experiments pathologic examination was performed to evaluate the spleen injury scaling. Results The sonographic pattern of lesions in the dogs＇ spleens at conventional ultrasonography was irregular and poorly- defined margins. The ruptures of spleen capsules were observed in some dogs. The different degrees of blood accumulation were found under the diaphragm and in abdominal cavity in all the cases. CEUS showed that the enhancement of injuried regions was characteristic in different phase when spleen parenchyma was damaged with active bleeding. The microbubbles flowed from the ruptures to the areas of blood accumulation just like “pouring spring” or “spurting”. The hematomas were not enhanced in every phase. Gross pathologic findings were consistent with the CEUS results. Conclusions CEUS can judge whether active bleeding or hematomas happened in spleens according to the enhancement characters in real time.