B超检查在闭合性肝外伤诊断中的应用价值

Application of B-Ultrasonography in Diagnosis of Blunt Hepatic Trauma

目的探讨B超检查在闭合性肝外伤诊断中的应用价值及注意事项。方法选择2007年1月—2008年10月在我院应用西门子公司SEQUIOA512彩色超声诊断仪(探头频率2.0～5.0MHz)诊断且经术后证实的48例闭合性肝外伤患者,回顾性分析患者的B超检查结果。结果48例患者中,肝脏真性破裂33例,被膜下破裂10例,中央型破裂5例。(1)真性破裂:肝脏外形增大,形态不规则,轮廓线中断;包膜不完整、断离、缺损,断离口周围常伴有不规则混合性强回声区,边界模糊;肝实质内可见强弱不均的杂乱回声,与正常肝组织无明显分界,损伤早期表现为不规则模糊的絮状、云雾状或斑块状强回声,随着时间的延长,病灶密度逐渐变为低回声或无回声液性暗区。肝肾间隙探及不等量的无回声区。(2)被膜下破裂:肝脏大小、形态正常,内部回声均匀,肝包膜强回声亮线与肝实质间出现无回声区,呈棱形改变,随着时间的延长,血肿机化时呈较强回声。(3)中央型破裂:肝脏肿大,形态异常,但包膜完整,内部回声紊乱,肝实质内出现不规则的液性暗区及强弱不均的回声区,边界欠清晰。结论B超检查诊断肝脏外伤方便、快捷、准确性高,具有重要的临床价值;但应注意随诊动态观察,难以探查的部位应扩大扫描视野,对肝脏周围及腹腔全面扫查,并进行必要的鉴别。

Objective To investigate the value and notes in application of B - uhrasonography in diagnosis of blunt liver trauma. Methods The data of 48 patients with blunt liver trauma diagnosed by Siemens color ultrasound diagnostic apparatus SEQUIOA512 （probe frequency of 2.0 -5.0 MHZ） and confirmed by the operation from January 2007 to October 2008 were retrospectively analyzed. Results Among 48 patients, there were 33 with true liver rupture, 10 with subcapsular rupture, and 5 with central - typed rupture. （ 1 ） True liver rupture ： The liver becomes enlarged with irregular appearance and discontinued contour lines ; non - intact, breakage or defect of the capsule, often with strong irregular mixed echo area around the opening of breakage, with no clear borderline ; in the liver parenchyma there are scattering echoes, either strong or weak, and with no evident boundary to normal liver tissue. At the early stage of trauma there are strong echoes that are irregularly flocculent, cloudy or plaque like; as the time goes on, the focal density gradually becomes lower echo or anechoic dark area. And unequal anechoic areas are found in the hepatorenal spatial. （2） Subcapsular rupture ： The live is normal in size and appearance, the inner echoes are even; anechoic area found in between the hepatocapsular echo line and the hepatic parenchyma is in a diamond and following the lasting of the time, it becomes stronger echo as the hematoma organizes. （3） Central - typed rupture ： The liver is swollen, but the capsule is intact, with no internal echoic disorder; there in the hepatic parenchyma irregularly liquid dark area and uneven echoic area with no clear borderline. Conclusion B - ultrasound diagnosis for liver trauma, being convenient, rapid and with high accuracy, is of important clinical value. However a dynamic follow - up observation should be conducted, the scanning field should be expanded for the site being difficult to be explored, all - round scanning of the sites around the liver and abdominal cavity needs to be done, and a necessary differentiation should be also performed.