迟发性闭合性胸部损伤的CT表现及动态观察

CT manifestations and dynamic follow-up observation of delayed closed thoracic trauma

目的：探讨 CT 对迟发性胸部损伤的诊断及动态变化，为临床及时准确治疗提供诊断依据。方法：回顾分析110例迟发性胸部损伤的 CT 和临床资料，对其 CT 表现及动态变化等进行分析。结果：迟发性胸部损伤大都于伤后24～48 h 内发生，其中肺挫伤93例，单纯气胸3例；气胸合并血胸2例；单纯出现血胸12例；肺挫伤伴发迟发性血胸69例，伴发率高达74％（69/93）。迟发性肺挫伤大多发生在右肺，占72．04％（67/93）；发生在下叶的迟发性肺挫伤又比上叶明显多见，占76．34％（71/93）。结论：CT 不仅能及时发现迟发性胸部损伤，还能对发生的部位、性质、损伤程度、并发症、预后等做出及时判断，为临床及时准确治疗提供诊断依据。应将伤后48h CT 复查列为常规。迟发性胸部损伤不易完全吸收，易遗留肺纤维化及胸膜增厚、粘连。

Objective：To study the value of CT in the diagnosis of delayed thoracic trauma and follow-up changes,in order to provide accurate basis for clinical treatment.Methods：The clinical and CT materials of 110 cases with delayed tho-racic trauma were retrospectively analyzed,the CT manifestations and the dynamic changes were studied.Results：Delayed thoracic trauma mostly occurred within 24~48h after injury,including pulmonary contusion （93 cases）,simple pneumotho-rax （3 cases）;pneumothorax in combination with hemothorax （2 cases）;simple hemothorax （12 cases）;pulmonary contu-sion accompanied with delayed hemothorax （69 cases）,with the incidence rate up to 74% （69/93 cases）.The delayed pul-monary contusion mostly occured in the right lung,accounted for 72.04% （67/93 cases）;delayed pulmonary contusion oc-curred in the lower lobe were much more than that in the upper lobe,accounted for 76.34% （71/93 cases）.Conclusion：CT scan can not only find out delayed thoracic trauma lesions,but also can precisely evaluate the position,pattern,degree of in-jury,complication as well as prognosis prediction,which provides diagnosis evidence for treatment timely and accurately.CT scanning 48h after trauma should be performed as a routinely practice.Lesions of delayed thoracic trauma can not be com-pletely absorbed,pulmonary fibrosis,pleural thickening and adhesion are sequela commonly seen.