MSCT增强扫描在肝脏创伤中的诊断价值及临床意义

Evaluation and clinical significance of contrast-enhanced MSCT in hepatic trauma

目的:探讨MSCT增强扫描在肝脏创伤中的诊断价值及临床意义。方法:选择我院诊治的29例肝脏创伤患者,全部患者在伤后20min至5d内进行了64层螺旋CT检查,其中14例患者行增强扫描,将肝脏创伤的影像表现与手术结果进行对照,并按肝脏钝性创伤标准(AAST)及Mirvis分级系统进行分级。结果:29例患者中,肝撕裂伤7例次、肝包膜下血肿19例次、肝内血肿16例次、门静脉周围轨迹征15例次、假性动脉瘤1例次、肝静脉损伤2例次、活动性出血1例次、胆汁瘤2例次、扁平下腔静脉征1例次。12例行手术治疗,其中11例患者的MSCT影像学表现与手术结果相吻合,1例因未行增强扫描结果为假阴性。结论:MSCT增强扫描能够比CT平扫提供更丰富的肝脏创伤信息,明确创伤的范围、程度,所显示的造影剂外漏、假性动脉瘤、肝静脉断裂是判断血管性损伤的可靠征象,对急诊肝脏创伤的诊断和治疗方式的选择具有重要指导意义。

Objective：To evaluate the value and of clinical significance of contrast-enhanced MSCT in hepatic trama.Methods：29 patients with hepatic trauma were selceted as the object in the study,all of the patients underwent the MSCT examination in 20 min ～ 5 days after the injury,and 14 patients received contrast-enhanced MSCT at the same time.We compared the CT findings with laparotomy results and classified severity of hepatic injury by AAST（American Association for the Surgery of Trauma） and Mirvis grade system.Results：In the 29 patients,hepatic laceration was found in 7 cases,subcapsular hematomas in 19 cases,parenchymal hematomas in 16 cases,periportal tracking in 15 cases,pseudoaneurysm in 1 case,injury of hepatic vein 2 cases,active bleeding in 1 case,biloma in 2 cases,flat IVC in 1 case.12 patients accepted laparotomy,one was missed diagnosis because of no contrast-enhanced CT.Conclusion：Compared to CT plain scan,contrast-enhanced MSCT can identify the extent and degree of the hapatic trauma with the affluent information of the injury,the active bleeding,pseudoaneurysm,hepatic injury is the reliable signs which can confirm the blood vessel injury,and it plays a vital role in the diagnosis of the hepatic injury and the choose of the treatment.