超声造影在腹部实质脏器外伤治疗中的作用

The role of contrast-enhanced ultrasound in management of abdominal organ trauma

目的探讨超声造影在腹部脏器外伤治疗方法的选择以及超声引导局部注射治疗中的作用。方法81例腹部外伤患者经超声造影检查明确脏器损伤分级,不同级别外伤患者结合生命体征情况采取相应的处理措施,包括保守治疗组（Ⅰ组）、超声造影引导注射治疗组（Ⅱ组）和手术治疗组（Ⅲ组）。在Ⅱ组中,由超声造影引导下,经皮穿刺对血肿和活动性出血部位分别注射蛇毒凝血酶和可吸收性氰基丙烯酸酯。结果81例患者中肝损伤35例,脾损伤28例,肾损伤17例,肝肾复合伤1例。Ⅰ组患者55例,经保守治疗50例痊愈,3例发生再出血,2例发生动脉瘤;Ⅱ组8例,超声引导下经皮局部注射治疗,止血效果明确,无并发症;Ⅲ组18例,经手术治疗。结论超声造影能够为腹部实质脏器外伤治疗方案的选择提供可靠依据,同时还可用于引导局部注射治疗,实现腹部脏器外伤的超声介入治疗。

Objective To study the role of contrast-enhanced ultrasound（CEUS）in selecting the management of abdominal organ trauma and the feasibility of hemostatic agents injected directly into wound sites by guidance of CEUS.Methods Eighty-one patients with abdominal organ trauma underwent CEUS examination and made the decision which management should be done according to general states of patients,which divided into three groups：the group of conservative treatment（group Ⅰ）,the group of CEUS-guided injective therapy（group Ⅱ）and the group of operative management（group Ⅲ）.For the patient of group Ⅱ,hemocoagulae and cyanoacrylate were injected into the haematoma and active bleed site percutaneous puncture respectively by the guidance of CEUS.Results Of all patients,there were thirty-five patients with hepatic trauma,twenty-eight cases with splenic trauma and eighteen cases with kidney trauma.Fifty-five cases of group Ⅰ were treated with conservative treatment and fifty cases were cured,three patients occurred rehaemorrhagia,whereas two patients occurred aneurysm.For eight patients of group Ⅱ,the haemostasis effect of CEUS-guided injective therapy was obvious and no complication was occurred.Eighteen patients performed operative management.Conclusions CEUS can provide reliable help for selecting therapy mode of abdominal organ trauma and can be used as guidance of injecting therapy,which realities the intervention therapy of abdominal organ trauma.