超声造影在犬肝外伤治疗方法选择中的作用

The role of contrast-enhanced ultrasound in selecting the management of hepatic trauma in experimental dogs

目的探讨超声造影在实验犬不同级别闭合性肝损伤治疗方法选择中的作用。方法21只实验犬按肝损伤程度进行超声造影分级并分组进行治疗观察。第1组5只,肝损伤I～Ⅲ级,无活动性出血,行保守治疗;第2组5只及第3组6只均为Ⅲ～Ⅳ级肝损伤,分别行保守治疗和超声造影引导局部注射蛇毒凝血酶联合应用氰基丙烯酸酯止血胶微创止血治疗;第4组5只,肝损伤Ⅳ级以上,行开腹手术治疗。结果第1组5只犬保守治疗均痊愈;第2组保守治疗效果不佳2只犬死亡,3只犬自行止血;第3组超声造影引导下局部注射止血药物,6只犬均治愈;第4组开腹行肝修补及止血治疗3只犬存活,2只犬死亡。结论超声造影可用于引导腹部实质脏器外伤局部注射治疗,可有效控制Ⅲ～Ⅳ级肝外伤出血,近期疗效明显,无明显不良反应和副作用。有望为临床肝外伤的救治提供新的诊断和治疗方法。

Objective To study the role of contrast-enhanced ultrasound （CEUS）in selecting the management of hepatic trauma models in experiment dogs. Methods Twenty-one dogs were classified into four groups according to the injured severity by using CEUS： Group one： the injuries in five dogs with conservative therapy were grade Ⅰ -Ⅲ without active bleeding; The injuries in five dogs in the Group two and six dogs in the Group three were both grade Ⅲ-Ⅳ. Dogs in Group two and three underwent conservative therapy and CEUS-guided injective therapy respectively. Hemocoagulase and cyanoacrylate were injected guided by CEUS in the dogs of Group three. Results Five injuries of Group one were recovered with the conservative therapy. Two injuries died and three were healed in the Group two. Six injuries of Group three were all recovered with CEUS-guided injective therapy. There were two died and three recovered after operation in the Group four. Conclusions CEUS, as guidance to injecting therapy in hepatic trauma, could have a positive control in a grade Ⅲ-Ⅳ of hepatic bleeding without any outstanding adverse effects. It could provide a new diagnosis tool and therapy for the clinical hepatic trauma.