多排螺旋CT在胸腹部联合损伤中的诊断价值

The Diagnostic Value of Multislice Spiral CT in the Chest and Abdomen Joint Injury

目的探讨多排螺旋CT在胸腹部联合损伤中的诊断价值。方法回顾性分析2011年8月至2015年8月我院86例经手术或随访证实的胸腹部联合损伤患者的完整CT影像资料,由两名放射科医师对其多排螺旋CT图像进行分析,最终与手术结果进行对比。结果 86例患者中,膈肌不连续29例,节段性膈肌不显影14例,膈疝21例,领口征14例,脏器下垂征18例,腹腔脏器上抬征21例,肠壁增厚和/或血肿6例,气腹8例。86例患者中,40例为穿通伤,46例为钝伤(其中20例交通伤,16例高坠伤,10例碾压伤)。手术证实膈肌破裂68例,膈肌未破裂18例。多排螺旋CT诊断右侧膈肌破裂准确率为88.4%,诊断左侧膈肌破裂准确率为90.7%。多排螺旋CT诊断血气胸、肺挫裂伤、纵隔出血、肾及肾上腺损伤准确率为100%,肝、脾、胰腺损伤诊断率分别为96.5%,96.5%,94.2%。结论放射科和急诊科医师均应熟悉胸腹联合损伤的多排螺旋CT表现,并尽可能准确发现膈肌破裂的各种征象,提高诊断准确性。

Objective To investigate the diagnostic value of multislice spiral CT in the chest and abdomen joint injury.Methods A retrospective analysis of complete CT image data from 86 chest and abdomen joint injury patients in our hospital confirmed by surgery or follow-up from August 2011 to August 2015,and two radiologists analyzed their multi-slice spiral CT images,the final results were compared with surgical. Results In 86 patients,29 cases＇ diaphragms were not continuous,14 cases＇ segmental diaphragms did not develop,21 cases were diaphragmatic hernia,14 cases had neck symptoms,18 cases had organ prolapse syndrome,21 cases had abdominal organs elevation syndrome,6 cases＇ bowel wall were thickening and / or had hematoma,8 cases had pneumoperitoneum. In 86 patients,40 cases had penetrating injury,46 cases were blunt trauma（ 20 cases of traffic injuries,16 cases of high-fall injuries,10 cases of RCC injury）. 68 cases of diaphragmatic rupture were confirmed by surgery,and 18 cases of unruptured diaphragm were confirmed,too. The accuracy rate of multi-slice spiral CT diagnosis in right diaphragm rupture was 88. 4%,in the left diaphragmatic rupture was 90. 7%. Multi-slice spiral CT diagnosis of pneumothorax,pulmonary contusion,mediastinal bleeding,kidney and adrenal gland damage was 100% accurate. In liver,spleen and pancreas damage detection,the rates were96. 5%,96. 5% and 94. 2%. Conclusion Radiology and emergency department physicians should be familiar with the images of thoraco-abdominal injury in multi-slice spiral CT,and should find various signs of diaphragmatic rupture as accurate as possible to improve diagnostic accuracy.