基于CT图像的腹部损伤腹腔内出血定量研究

Quantitative study of abdominal hemorrhage in abdominal trauma based on computed tomography images

目的探讨CT计量法计算腹部损伤腹腔内出血体积的可行性及准确性。方法采用回顾性病例对照研究分析2009年1月-2016年9月76例诊断为腹腔内出血（或腹腔积血）行急诊手术患者的临床资料。基于CT图像，采用CT计量法（Noboru Oriuchi公式）计算腹腔内出血量，并与术中实际记录的腹腔内出血量（手术计量法）进行比较，利用SPSS21．0统计软件对数据进行统计分析，并对两种测量方法所得结果进行线性回归分析。结果通过CT计量法腹腔内出血量为10～4335ml，手术计量法腹腔内出血量为200～4490ml。这两种方法所得腹腔内出血量体积差的绝对值为4．8—500ml。体积差／手术计量法腹腔内出血量为0．2％～95．0％[4．5％（2．8％，8．9％）]。腹腔内出血量〈500ml，体积差异的比值为30.0％-95．0％[69．1％（51．2％，78．6％）]；腹腔内出血量〉500ml，其体积差异的比值为0．2％～13．6％[4．2％（2．7％，6．4％）]。排除出血量〈500ml的患者后，CT计量法腹腔内出血量与手术计量法腹腔内出血量呈直线相关趋势（r=0．971，P〈0．05）。结论对于腹腔内出血量〉500ml的患者，行常规全腹部CT扫描后，可通过CT计量法的Noboru Oriuchi公式较精确地计算患者腹腔内出血的体积，指导手术治疗。

Objective To verify the feasibility and accuracy of the quantitative evaluation of the volume of internal abdominal hemorrhage based on CT images. Methods The clinical data of 76 patients diagnosed as abdominal hemorrhage or hemoperitoneum and performed with emergency surgery in the Second Affiliated Hospital to Wenzhou Medical University from January 2009 to September 2016 were retrospectively analyzed by case-control study. The Noboru Oriuchi＇s formula was used to calculate the volume of abdominal hemorrhage based on CT images, and the results were compared and adjusted with the volume of actual abdominal hemorrhage recorded during the operation. SPSS 21.0 was used to statistically analyze the data. The linear regression was analyzed on the results measured by the two methods. Results The volume of abdominal hemorrhage measured by the CT calculation method ranged from 10 to 4 335 ml, while the corresponding volume measured by operational calculation method ranged from 200 ml to 4 490 ml. The absolute difference in the volume measured by these two methods ranged from 4.8 ml to 500 ml. The ratio of the absolute difference to the volume of abdominal hemorrhage by operational calculation method ranged from O. 2% to 95.0%, the median of which was 4.5% （2.8%, 8.9% ）. When the exact volume of abdominal hemorrhage was 〈 500 ml, the absolute difference in the exact volume ranged from 30.0% to 95.0% , the median of which was 69. 1% （51.2%, 78.6% ）. When the volume was less than 500 ml, the ratio ranged from 0.2%-13.6% , the median of which was 4. 2% （2.7%, 6.4% ）. Analysis of the numbers of the two measuring methods with linear correlation method after eliminating the cases in which the bleeding volume was less than 500 ml showed that two methods presented a linear correlation （ r = 0. 971, P 〈 0.05 ）. Conclusion After the conventional abdominal CT scanning, the Noboru Oriuchi＇s formula can be used to accurately calculate the volume of abdominal hemorrhage in patients with volume of abdominal hemorrhage more than 500 ml.