多层螺旋CT应用于急诊外伤性脾脏损伤诊断与治疗的临床价值分析

Clinical evaluation of MDCT applied to the diagnosis and treatment of traumatic spleen injury in emergency

目的探讨多层螺旋CT在急诊外伤性脾脏损伤诊断及指导临床治疗方面的应用价值。方法对2014年11月-2016年12月北京市红十字会急诊抢救中心收治的180例闭合性脾脏损伤并手术证实的患者进行超声、cT及临床资料的回顾性分析，比较cT和超声的诊断符合率。结果180例脾损伤中I级（包膜下血肿）58例、Ⅱ级（脾外周撕裂）56例、Ⅲ级（脾实质撕裂）42例、Ⅳ级（粉碎性脾破裂）24例，其中I级及部分Ⅱ级患者给予保守治疗成功90例，其余90例行手术治疗。术前cT。诊断符合率98．9％，明显高于超声诊断的83．3％（P〈0．05），对于术前其他合并伤的检出率cT高于超声。结论多层螺旋cT检查对急诊外伤性脾损伤术前诊断符合率高，对临床合理制定治疗方案有指导意义，是急诊创伤患者诊断脾脏损伤的首选检查方法之一。

Objective To study the value of MDCT in the emergency diagnosis and guiding treatment in splenic injury. Methods From November 2014 to December 2016, in our hospital 180 cases clinical data of patients with blunt splenic injury screened by ultrasound, CT and some confirmed by surgery were retrospectively analyzed with comparison of CT and ultrasound diagnosis coincidence rate. Results Of 180 cases of spleen injury, there were grade Ⅰ （subcapsular hematoma） 58 cases, grade Ⅱ （spleen peripheral tear） 56 cases, grade Ⅲ （spleen parenchyma tear） in 42 cases, grade Ⅳ （comminuted spleen rupture） 24 cases. 90 cases grade I and some grade Ⅱ of these patients were given conservative treatment successfully, the other 90 cases received routine surgery. Preoperative CT diagnosis coincidence rate was 98.9%, significantly higher than that of ultrasonic diagnosis of 83.3% （P〈0.05）, and other combined injury detection rate in preoperative diagnosis by computed tomography （CT） was higher than that of ultrasound. Conclusion The preoperative diagnosis coincidence rate of multislice CT examination in emergency traumatic splenic injuries is high. MDCT has guiding significance to the treatment for clinical reasonable formulation, and it is one of the first choice for the diagnosis of splenic injury in emergency trauma patients.