猪胸部枪弹伤后胸部螺旋CT检查的应用价值探讨

Clinical significance of MSCT in revealing thoracic gunshot wound in pigs

目的:利用64层螺旋CT容积扫描及重建技术探讨猪胸部枪弹伤后胸部影像学表现,结合解剖结果加以分析,为胸部枪弹伤的早期、全面救治提供参考依据。方法:建立猪胸部枪弹伤动物模型10只,致伤后2 h内行胸部64层螺旋CT容积扫描及三维重建,其后解剖。结果:(1)2只(4、10号)弹道出口处粉碎性肋骨骨折,大量出血致失血性休克及右肺功能丧失而死亡。2只(1、9号)CT及解剖出血量有较大差异,提示损伤的右肋间后动脉持续出血可能,符合数小时后解剖发现右侧胸腔积血量明显增加改变。1只(8号)出血量有部分增加,结合CT表现考虑为右肋间后动脉副支损伤导致出血。2只(5、7号)双肺散在渗出性积液、积血,肺组织外观呈暗红色团片影与正常萎缩肺组织相间分布,结合死亡时间,提示5号为急性呼吸衰竭死亡,而7号为继发呼吸衰竭而死亡。(2)肺组织解剖标本测值,弹道区变化不明显,挫伤区及震荡区较CT检查结果明显缩小,考虑为肺组织萎缩后弹道区因血凝块充填,萎缩程度小,而挫伤区及震荡区相反则萎缩程度大。结论:64层螺旋CT不但能清晰显示胸部枪弹伤后血气胸程度,而且能较好地显示枪弹所致肺组织损伤及肋间动脉、胸廓内动脉损伤等易被忽视的致死性损伤,为降低此类患者的死亡率,提高临床救治水平起到重要作用。

Objective.To study the values of MSCT scanning and three - dimensional reconstruction in revealing the thoracic gunshot wound. Methods：The model of thoracic gunshot wound was established in 10 pigs, and their chest walls and lungs were scanned and reconstructed three - dimensionally by MSCT after they were shot two hours later. The films of MSCT were studied. Results：Two pigs suffered from comminuted fracture of ribs at the ballistic exit and died of hemorrhagic shock and loss of function caused by right massive bleeding. There was a great difference of the amount of bleeding between CT diagnosis and autopsy, which indicated that a continuous bleeding from right posterior intercostal artery existed. The amount of bleeding increased in one pig and its CT performance indicated the injury of para - posterior intercostal artery. It was found that there were exudative fluid and hematocele in both lungs of two pigs, and their lung tissues appeared mission shadow. Based on the lung tissue anatomic examination, the ballistic area was not obviously different from that on the films of MSCT, but the ballistic area and shock area were significantly smaller than those on the films of MSCT. Conclusion：MSCT scanning and reconstructing can not only reveal hemopneumothorax, but also do the bullet wounds in the lungs, posterior intercostal arteries and internal thoracic artery. It is an important equipment diagnosing the thoracic gunshot wound.