超声造影诊断肝破裂的临床应用研究

Study on clinical application of contrast-enhanced ultrasoound in diagnosis of hepatorrhexis

目的评价超声造影检查在肝破裂诊断中的临床应用价值。方法收集2012年12月-2015年6月广西医科大学第一附属医院收治的28例肝破裂（包括外伤性和自发性破裂）超声造影声像图特征。观察肝损伤的部位及损伤程度,比较常规超声与超声造影对肝破裂诊断准确率,所有病例均由CT及手术证实。结果超声造影观察下,19例肝癌患者中8例破裂口未见造影剂明显移动,破裂口周围可见积血及血肿,11例破裂口处可见造影剂自破裂口向肝外呈＂喷射状＂＂泉涌状＂移动：7例外伤性肝破裂患者中3例为肝破裂肝包膜下血肿,肝内病灶中央造影全程始终无增强,周边呈点线状增强,包膜下血肿全程始终无增强,另4例破裂病灶内造影全程中央始终无增强,周边呈点线状增强,其中2例破裂口处可见造影剂自破裂口向肝外呈＂云雾状＂扩散：2例自发性肝脓肿破裂患者肝边缘破裂口处可见造影剂自破裂口向肝外呈＂喷射状＂移动。常规超声对自发性肝癌破裂、外伤性肝破裂和自发性肝脓肿破裂的诊断准确率分别为73.7%、85.7%和100.0%：超声造影诊断准确率均为100.0%。超声造影诊断肝破裂的诊断准确率显著高于常规超声,两者比较差异有统计学意义（P〈0.05）。结论超声造影可实时、动态地观察闭合性肝损伤的部位、范围及是否有活动性出血的情况,对临床治疗具有重要的参考价值。

Objective To evaluate clinical application value of contrast-enhanced ultrasound（CEUS） in the diagnosis of hepatorrhexis.Methods From December 2012 to June 2015,in First Affiliated Hospital of Guangxi Medical University,ultrasound imaging characteristics of 28 patients with hepatorrhexis（including traumatic and spontaneous rupture）were collected.The injury location and extent of damage were observed,the accuracy of conventional ultrasound and contrast-enhanced ultrasound in diagnosis of hepatorrhexis were compared.All cases were confirmed by CT and surgery.Results Under the observation of CEUS,8 cases of 19 hepatic carcinoma patients with hepatorrhexis showed blood and hematoma around the rupture without significant movement of the contrast agent,and other 11 cases showed ＂jet-like＂ movement of contrast agent form the rupture.3 cases of 7 patients with traumatic hepatic rupture were liver subcapsular hematoma,which showed no enhancement in the center of lesion and the subcapsular hematoma,but it showed pointed-like enhancement around the lesion.The other cases showed no enhancement in the center of lesion,but 2 cases showed pointed-like enhancement around the lesion and ＂cloudy＂ diffusion from the rupture.2 cases of spontaneous rupture showed ＂jet-like＂ movement of the contrast agent from the rupture.The diagnostic accuracy rate of conventional ultrasound in hepatic carcinoma hepatorrhexis,traumatic hepatic rupture and spontaneously liver abscess rupture was 73.7%,85.7%and 100.0%;CEUS diagnostic accuracy rate was 100.0%.Diagnostic accuracy of CEUS diagnosis was significantly higher than conventional ultrasound;the difference was statistically significant（P0.05）.Conclusion Real-time CEUS can be applied for dynamic observation of the location,extent or active bleeding of liver rupture,which has important reference value for clinical treatment.