超声造影引导肝脾创伤介入性治疗的实验研究

Interventional treatment of hepatic or splenic trauma under the guidance of contrast-enhanced ultrasound：an animal experiment

目的探讨超声造影引导局部注射治疗闭合性肝、脾创伤出血的价值。方法使用健康成年杂种犬。用自制的小型生物撞击器建立肝和脾闭合性外伤模型。符合美国创伤外科协会分级（AAST）的Ⅲ～Ⅳ级的28只犬纳入实验，并随机分为治疗组与对照组，治疗组采用超声造影引导病灶内注射蛇毒凝血酶和α-氰基丙烯酸酯黏合胶，对照组于病灶局部注射等量的生理盐水。结果两组动物注射干预后均存活。治疗组注射治疗后超声造影复查显示病灶内无活动性出血，处死动物后开腹见病灶局部被血凝块及止血胶膜覆盖，腹腔出血量明显少于对照组（P=0．000）。对照组注射后病灶仍有出血。结论超声造影引导局部注射治疗Ⅲ～Ⅳ级闭合性肝、脾创伤出血，效果明确，可实现即刻止血。超声造影既可对肝、脾外伤进行准确、迅速诊断，同时可在其引导下进行局部穿刺注射治疗。

Objective To determine whether hemostatic agents directly injected into injury sites under the guidance of contrast-enhanced ultrasound（CEUS） can effectively control hemorrhage from hepatic or splenic trauma. Methods Healthy adult dogs were impacted by a impactor to create hepatic or splenic trauma. Among 32 dogs,28 had hepatic or splenic injury of grade Ⅲ～Ⅳ according to Iniury Scale of the American Association for the Surgery of Trauma （AAST）, which were divided into two groups, the treatment group and the control. In the treatment group, hemocoagulase and α-cyanoacrylate were injected respectively into the injury site and transected micro-vessel under the guidance of CEUS, while in the control group,normal saline was injected. Results All animals of the two groups survived after the injection. CEUS demonstrated that active hemorrhage disappeared in treatment group but still existed in the control group. In the treatment group, laparotomy showed that hepatic or splenic injury had been covered and adhered with clot and glue membrane of hemostatic agents and free intraperitoneal blood volume was significantly less than that in the control group（ P = 0. 000）, while in the control group injury bleeding did not stop after injection. Conclusions Hemostatic agents injected under the guidance of CEUS can effectively control hemorrhage from hepatic or splenic trauma of grade Ⅲ～Ⅳ. This therapy was simple, convenient and effective. It may be performed immediately after hepatic or splenic injury was diagnosed.