CT诊断肠系膜挫裂伤及其并发症的临床应用

CT scan diagnosis of mesenteric contusion and its complications in the clinical application

目的探讨腹部外伤后CT诊断肠系膜挫裂伤及其并发症的临床应用价值。方法由3名高年资医师对23例经手术和临床治疗证实的肠系膜挫裂伤CT平扫资料进行盲法分析,分析有无肠系膜及周围间隙内脂肪密度增高、肠间隙内有无积液,及结肠下间隙、结肠旁沟及盆腔内有无积液,以综合资料作为诊断依据。结果 CT表现为单纯肠系膜及周围间隙脂肪密度增高3例,肠系膜及周围间隙脂肪密度增高合并结肠下间隙积液20例,合并肝脾周围间隙、结肠旁沟内积液15例,合并盆腔积液5例。外伤的部位在中上腹部17例,中腹部3例,下腹部3例。其中,下腹部1例明显见肠壁水肿,肠管穿孔造成周围间隙积气1例。经20例手术治疗患者证实,均见创伤部位腹壁皮下软组织肌肉挫伤明显,皮下肌间隙有淤血,腹或盆腔内见血凝块及血性液体。血凝块及不凝血大小、血量不等。小肠系膜及根部有不同程度、不同范围挫裂伤,伴有多处动静脉血管破裂性活动性出血,小肠有多处浆膜挫裂伤,19例未见小肠穿孔。1例见小肠肠壁0.5cm裂口,小肠内容物漏出,周围网膜包绕。15例出血位于肠系膜上动脉供血区域;4例位于肠系膜下动脉供血区,其中1例见肠壁穿孔;1例腹部保健患者出血来源余肠系膜上动脉及大网膜。20例均见出血积于小肠肠间隙;15例出血累积达肝脾周围间隙、结肠旁沟内;3例到达盆腔。结论对腹部有明确外伤史的患者进行常规腹部CT平扫检查,能较准确判断患者有无肠系膜挫裂伤及并发症发生,为临床诊断、治疗提供重要依据。

Objective To investigate CT diagnosis of mesenteric laceration and its complications caused by the abdominal trauma.Methods he CT scan images,clinical history and symptoms of 23 cases which proved to mesenteric laceration by surgery and clinical treatment were analyzed with blinded analysis by the three physicians.If there some fluid in the gap of intestinal,and if the lower colon space,paracolic gutter and pelvis with or without effusion,diagnosis would base on comprehensive information.Results CT showed 3 cases only the fat density surrounding the mesenteric increased,20 cases the fat density surrounding the mesenteric increased and effusion in the lower colon space,15 cases with effusion in the gap around the liver and spleen and paracolic gutter,5 cases with effusion in pelvis.The site of trauma on the upper abdomen 17 cases,on the abdomen 3 cases,on the lower abdomen 3 cases.Among them,one case in lower abdomen obvious saw the bowel wall edema,one case had air around the space caused by intestinal perforation.Confirmed by surgery,20 cases of surgical treatment patients were seen subcutaneous soft tissue under the trauma site was obvious muscle contusion,Subcutaneous muscle space there is congestion,abdominal or pelvic see blood clots and bloody fluid.Blood clots＇ size is not the same.Mesenteric and roots had varying degrees and range contusion,with multiple ruptured arteriovenous active bleeding,small bowel with multiple serosal contusion,19 cases of no intestinal perforation contusion.1case saw the small intestine wall had 0.5Cm gap,intestinal contents flew out,surrounded by omentum wrapping.Found 15 cases of bleeding in the area of superior mesenteric artery;4 cases in the inferior mesenteric artery territory,one of them had intestinal perforation;1 case of abdomen health patients bled from superior mesenteric artery and omentum.20 cases were seen blood in the space of small intestine;15 cases bled reach the gap of the liver and spleen,effusion in paracolic gutter;Three cases had reached the pelvic.Conclusion The normal abdominal CT scan examination for the patient who has clear history of trauma to the abdomen can accurately determine whether patients with mesenteric laceration and complications happen,provide guidance to the clinical diagnosis,also the important means to help clinical departments determine the related treatment.