多层螺旋CT对外伤性脾破裂的诊断及临床意义

Multislice spiral CT in diagnosis and clinical significance of traumatic rupture

目的讨论螺旋CT对外伤性脾破裂的诊断及临床意义。方法回顾性分析32例外伤性脾破裂患者的CT影像资料,其中27例经手术证实,2例经保守随诊证实,3例死亡病例表现典型。所有患者均进行平扫,其中3例可疑及5例阴性患者进行增强扫描。结果 32例均行CT平扫,平扫可明确脾破裂的24例,可疑脾破裂的3例,未见明显异常的5例,诊断敏感性84.3%、特异性75.0%。其中增强扫描后可疑及完全阴性病例患者均能明确诊断为脾破裂(敏感性100%、特异性100%)。病例中完全性脾破裂6例,中心性脾破裂8例,包膜下破裂17例,其他混合性脾破裂1例。结论 CT作为一种非损伤性检查手段,能迅速、准确评估脾损伤程度及出血的部位、大小以及腹腔伴随性损伤,对外伤性脾破裂的诊断有较高的敏感性和特异性。增强扫描在外伤性脾破裂诊断中非常重要,能明显提高诊断准确率,且能够进行正确的诊断和分型,也可同时发现脾脏周围器官的损伤,并对脾破裂治疗方法的选择具有指导意义,是外伤性脾破裂最重要的检查方法之一。

Objective To discuss the diagnosis and clinical significance of the spiral CT of traumatic rupture. Methods A retrospective analysis of 32 cases with splenic injuries in patients with CT image data,of which 27 cases confirmed by surgery,two cases confirmed by the conservative and followed up,three cases of deaths in performance were typical.All patients underwent enhancement,three cases of suspicious and 5 cases of patents with negative enhanced scan. Results 32 cases underwent CT plain,plain clear splenic rupture 24 cases,three cases of suspicious splenic rupture,and no obvious abnormalities in five cases,the diagnostic sensitivity was 84.3%,specificity was 75.0%.Enhanced scan suspicious and completely negative cases patients could be clearly diagnosed as splenic rupture（sensitivity 100%,specificity 100%）.Six cases of complete rupture of spleen in the case,the center of splenic rupture eight cases of subcapsular rupture in 17 cases,other mixed rupture. Conclusions CT,as a non-invasive examination methods,can quickly and accurately assess the degree of splenic injury and hemorrhage location,size,and the abdominal cavity accompanied by injury,the diagnosis of traumatic rupture of a high sensitivity and specificity.Enhanced scan in the diagnosis of traumatic rupture is very important and can significantly improve the diagnostic accuracy,and to carry out the correct diagnosis and classification,can also be found that the damage of the spleen and surrounding organs,and splenic rupture choice of treatment of guiding significance traumatic splenic rupture is the most important screening method.