超声检测在腹部创伤性肝脏破裂分级诊断中的应用价值

The value of ultrasonography in the diagnosis ofabdominal traumatic rupture of the liver

目的探讨超声检测在腹部创伤性肝脏破裂分级诊断中的应用价值。方法 2017年1月—2017年12月郑州人民医院治疗疑似肝破裂患者64例,其中男性41例,女性23例;年龄16～64岁,平均45. 0岁。受伤至就诊时间1～19h,平均5h。均行增强CT和超声检查,将检查结果与手术结果进行比较分析。结果手术探查确诊肝破裂患者57例;超声诊断肝破裂灵敏度和准确率分别为92. 98%和92. 19%,明显高于CT检查(分别为78. 95%和76. 56%,P <0. 05);超声和CT诊断肝破裂特异度和阳性预测值、阴性预测值比较差异无统计学意义(P> 0. 05); CT肝破裂分型与手术分型Kappa值为0. 437(P=0. 000);超声肝破裂分型与手术分型Kappa值为0. 765(P=0. 000);超声肝破裂分型正确率82. 81%,明显高于CT分型(57. 81%),差异有统计学意义(P=0. 002)。结论超声检测在腹部创伤性肝脏破裂诊断中有较好的应用价值,其检查快捷、简单、准确率高,同时其损伤程度分级诊断较可靠。

Objective To explore the value of ultrasonography in the diagnosis of abdominal traumatic rupture of the live.Methods From Jan.2017 to Dec.2017,64 cases of suspected liver ruptures in our hospital were examined by CT and ultrasonography.There were 41 males and 23 females,with an arerage age of 45.0 years(16-64 years).The time from injury to treatment was 1-19 h,with an average of 5h.The results were compared with surgical results.Results Totally 57 cases of liver rupture were diagnosed by surgical exploration.The sensitivity and accuracy of ultrasonic diagnosis of liver rupture were 92.98%and 92.19%,respectively,which were significantly higher than those of CT(P<0.05).The difference of specificity and positive predictive value and negative predictive value in ultrasonographic and CT diagnosis of hepatic rupture were not statistically significant(P>0.05).The Kappa value of CT liver rupture classification and operation classification was 0.437(P=0.000);The Kappa value of ultrasonic liver rupture classification and operation classification was 0.765(P=0.000).The correct rate of ultrasonic liver rupture classification was 82.81%,which was significantly higher than that of CT typing,and the difference was statistically significant(P=0.002).Conclusion Ultrasonography has a good application value in the diagnosis of abdominal traumatic liver rupture.Its examination is fast,simple and accurate,and its liver injury classification is reliable.