儿童肝脏钝性创伤的CT诊断

CT diagnosis of blunt hepatic injury in childhood

目的 :探讨CT对儿童肝脏钝性创伤诊断的价值与限度。方法 :分析 14 3例儿童肝脏钝性创伤的CT表现 ,年龄 2 0小时～ 14岁 ,平均 5 .6岁。创伤原因主要为车祸 89例 ( 62 .2 %) ,其次是坠落伤 2 7例 ( 18.9%)。全部病例采用Tepas儿童外伤评分 (PTS) ,均行增强CT扫描并按肝脏钝性创伤分级标准及Mirvis分级系统进行分级。 结果 :肝脏右叶损伤 12 5例 (占 87.4%)。肝脏创伤Ⅰ级 2 6例 ,Ⅱ级 40例 ,Ⅲ级 5 3例 ,Ⅳ级 19例 ,Ⅴ级 5例。其中 ,肝包膜下血肿 97例 ,单发或多发肝脏撕裂伤 95例 ,肝实质内血肿 3 5例 ,胆道损伤 15例 ,10 7例合并腹腔血肿。直接手术者 18例 ,保守治疗失败 17例 ,死亡 5例。结论 :CT增强检查是明确肝脏钝性创伤类型和范围的必要条件 ,增强检查所显示的对比剂外溢是判断活动性出血的可靠征象。CT的准确分级、活动性出血、腹腔积血量及PTS评分可综合作为选择手术或非手术治疗的指标。

Objective:To evaluate the usefulness of CT in the diagnosis of blunt hepatic injury in childhood.Methods:CT manifestations of 143 patients with blunt hepatic injury were analyzed,aged between 20 hours post partum and fourteen years,mean 5.6 years.The main causes of injury were traffic accident (n=89),fall (n=27),and birth injury (n=14).All patients were evaluated with PTS and examined by contrast enhanced CT (CECT).Results:Right lobe of liver was the most common site of blunt hepatic injury (125 cases).Hepatic injury was graded using the CT scan classification:gradeⅠ 26 cases,gradeⅡ 40 cases,grade Ⅲ 53 cases,grade Ⅳ 19 cases and grade Ⅴ 5 cases.There were hepatic subcapsular hematoma 97 cases,laceration 95 cases,parenchymal hematoma 35 cases,bile duct injury 15 cases and hemoperitoneum 107 cases.Conclusion:CECT is a necessary method to define the grade and extent of blunt hepatic injury,and contrast material extravasation is a reliable sign to identify active hemorrhage.Accurate CT scan classification,active bleeding,volume of hemoperitoneum and PTS are important reference standards for choice between operative and nonoperative management of liver injuries.