腹部创伤的急诊CT与术后分析(1)
【摘要】目的:探讨急诊CT扫描在腹部创伤中的应用价值。方法:收集整理我院2008.1月至2010.6月经手术证实的腹部创伤56例急诊CT检查的影像资料,进行回顾性分析判断。结果:腹部创伤的急诊CT扫描主要表现为肝脏、脾脏、肾脏的轮廓不清呈混杂高密度影像,包膜下积血,腹膜后血肿,腹腔积血,气腹。本组56例腹部创伤患者中,肝脏损伤6例、脾32例、肾6例,肠系膜与肠管损伤5例,复合性实质性脏器损伤8例。其中47例伴腹腔积血,18例合并肋骨骨折,25例有肺挫伤,4例合并腰椎横突骨折,2例腰椎压缩骨折。结论:急症CT检查对诊断腹部创伤具有很大的诊断价值,能够迅速准确的检出脏器损伤的部位,评估损伤程度,为临床制定有效的治疗方案提供重要依据。
【关键词】腹部闭合性创伤;体层摄影术;X线计算机
【中图分类号】R814.42 【文献标识码】A 【文章编号】1008-6455(2010)08-0377-02
, http://www.100md.com Abdominal trauma emergency CT and postoperative analysis
Yang Yubing1 Xu Bolin1 Li Jili2 Dong Yongguang2
【Abstract】Objecave:To investigate the applicable value of acute CT in abdominal trauma. Methods: collected on 56 patients with abdominal trauma emergency CT examination of the image data confirmed by surgery in our hospital from 2008.1 to 2010.6.in order toinvestigate the applicable value of acute CT in abdominal trauma. Methods: collected on 56 patients with abdominal trauma emergency CT examination of the image data confirmed by surgery in our hospital from 2008.1 to 2010.6.in order to retrospective analysis and judge.Results: Abdominal trauma emergency CT scans showed the Clear outline of theliver spleen and kidney were mixed withhigh-density image,Subcapsular hematoma, Retroperitoneal hematoma and or Hemoperitoneumm,Pneumoperitoneum. In the group of 56 patients with abdominal trauma patients, With liver injury in 6 cases, 32 cases of spleen, kidney in 6 cases, 5 cases of mesenteric and bowel injury, compound 8 cases of substantial organ damage. 47 cases with abdominal hemorrhage, 18 cases with rib fractures, 25 patients with lung contusion, 4 cases with lumbar transverse process fractures, 2 cases of vertebral compression. Conclusion: CT examination in the diagnosis of acute abdominal trauma has great diagnostic value, can be detected quickly and accurately the site of organ injury, damage assessment. Effective treatment for clinical development, providing an important basis.
, http://www.100md.com
【Key words】blunt abdominal trauma; tomography;X-ray computed
腹部损伤临床上非常常见,随着交通工具的快速发展,交通创伤引起的腹部外伤日益增多。过去,临床诊断的难点在于腹壁挫伤的同时是否伴有内脏脏器损伤。确诊内脏损伤较为困难,往往需经严密的临床观察、腹腔穿刺、连续血象检测、普通X线检查等等。常常不能确定内脏损伤的有无,至于部位、程度等更不能诊断,而依赖于剖腹探查。自1972年CT问世以来,特别是近年多层螺旋CT的出现,CT对腹部创伤诊断提供了一个安全、快捷、详尽的诊断方法,有力地配合了临床医师的诊断。多层螺旋CT已被视为急诊肾损伤的首选检查[1]。
1 资料与方法
1.1 一般资料:本组56例患者中,男46例,女10例,年龄16岁～69岁,车祸45例,占80.3%,暴力殴打6例,占10.7%,坠落伤5例,占9%。所有患者均在受伤后30min～24h内进行平扫检查。56例中单一脏器损伤为48例,受伤脏器依次为脾脏32例,肾脏6例,肝脏6例。多脏器损伤为8例,为二个或二个以上脏器复合伤。56例病例中全部经手术证实。
, http://www.100md.com
1.2 方法:采用GESpright16层全身CT扫描仪,层厚5mm～75mm,层距5mm～7.5mm,窗位40Hu～60Hu,窗宽180Hu～350Hu,所有患者均作CT平扫。
2 结果
2.1 CT表现
2.1.1 肝挫裂伤,本组6例,表现为条状或斑片状低密度影,密度欠均匀,夹杂等密度和稍高密度影,挫裂肝边缘境界模糊。肝周边可见线条状稍高密度影。
2.1.2 肝内血肿1例,表现为肝内团块状高密度影。
2.1.3 肝包膜下血肿,本组6例,均和肝挫伤并存,表现为肝周边梭形或线条稍高密度影。
2.1.4 脾挫裂伤本组32例,其中8例为复合伤。表现为脾周线条状高密度影,局部脾实质的密度不均匀,轮廓模糊,增大。脾实质内可见一些散在的稍高密度的斑片状影。
2.1.5 脾包膜下血肿本组32例均和脾挫裂伤并存,为脾边缘线带状或新月形稍高密度影。
2.1.6 肾挫裂伤 本组6例,表现和脾挫裂伤相似。其中2 例为肾蒂断裂,表现为肾脏移位,旋转,肾门向前,腹膜后血肿。
2.1.7 胰腺损伤本组1例,为胰尾部横断,表现为胰尾明显增粗,密度增高,周围有高密度血肿。
2.1.8 消化道破裂 本组5例,小肠破裂2例,乙状结肠系膜损伤2,复合伤1 例,大网膜囊撕裂1例。2例表现为腹腔内的游离气体,常位于上腹腔间隙内,同时见少量积液。肠壁间血肿3例。, 百拇医药
【关键词】腹部闭合性创伤;体层摄影术;X线计算机
【中图分类号】R814.42 【文献标识码】A 【文章编号】1008-6455(2010)08-0377-02
, http://www.100md.com Abdominal trauma emergency CT and postoperative analysis
Yang Yubing1 Xu Bolin1 Li Jili2 Dong Yongguang2
【Abstract】Objecave:To investigate the applicable value of acute CT in abdominal trauma. Methods: collected on 56 patients with abdominal trauma emergency CT examination of the image data confirmed by surgery in our hospital from 2008.1 to 2010.6.in order toinvestigate the applicable value of acute CT in abdominal trauma. Methods: collected on 56 patients with abdominal trauma emergency CT examination of the image data confirmed by surgery in our hospital from 2008.1 to 2010.6.in order to retrospective analysis and judge.Results: Abdominal trauma emergency CT scans showed the Clear outline of theliver spleen and kidney were mixed withhigh-density image,Subcapsular hematoma, Retroperitoneal hematoma and or Hemoperitoneumm,Pneumoperitoneum. In the group of 56 patients with abdominal trauma patients, With liver injury in 6 cases, 32 cases of spleen, kidney in 6 cases, 5 cases of mesenteric and bowel injury, compound 8 cases of substantial organ damage. 47 cases with abdominal hemorrhage, 18 cases with rib fractures, 25 patients with lung contusion, 4 cases with lumbar transverse process fractures, 2 cases of vertebral compression. Conclusion: CT examination in the diagnosis of acute abdominal trauma has great diagnostic value, can be detected quickly and accurately the site of organ injury, damage assessment. Effective treatment for clinical development, providing an important basis.
, http://www.100md.com
【Key words】blunt abdominal trauma; tomography;X-ray computed
腹部损伤临床上非常常见,随着交通工具的快速发展,交通创伤引起的腹部外伤日益增多。过去,临床诊断的难点在于腹壁挫伤的同时是否伴有内脏脏器损伤。确诊内脏损伤较为困难,往往需经严密的临床观察、腹腔穿刺、连续血象检测、普通X线检查等等。常常不能确定内脏损伤的有无,至于部位、程度等更不能诊断,而依赖于剖腹探查。自1972年CT问世以来,特别是近年多层螺旋CT的出现,CT对腹部创伤诊断提供了一个安全、快捷、详尽的诊断方法,有力地配合了临床医师的诊断。多层螺旋CT已被视为急诊肾损伤的首选检查[1]。
1 资料与方法
1.1 一般资料:本组56例患者中,男46例,女10例,年龄16岁～69岁,车祸45例,占80.3%,暴力殴打6例,占10.7%,坠落伤5例,占9%。所有患者均在受伤后30min～24h内进行平扫检查。56例中单一脏器损伤为48例,受伤脏器依次为脾脏32例,肾脏6例,肝脏6例。多脏器损伤为8例,为二个或二个以上脏器复合伤。56例病例中全部经手术证实。
, http://www.100md.com
1.2 方法:采用GESpright16层全身CT扫描仪,层厚5mm～75mm,层距5mm～7.5mm,窗位40Hu～60Hu,窗宽180Hu～350Hu,所有患者均作CT平扫。
2 结果
2.1 CT表现
2.1.1 肝挫裂伤,本组6例,表现为条状或斑片状低密度影,密度欠均匀,夹杂等密度和稍高密度影,挫裂肝边缘境界模糊。肝周边可见线条状稍高密度影。
2.1.2 肝内血肿1例,表现为肝内团块状高密度影。
2.1.3 肝包膜下血肿,本组6例,均和肝挫伤并存,表现为肝周边梭形或线条稍高密度影。
2.1.4 脾挫裂伤本组32例,其中8例为复合伤。表现为脾周线条状高密度影,局部脾实质的密度不均匀,轮廓模糊,增大。脾实质内可见一些散在的稍高密度的斑片状影。
2.1.5 脾包膜下血肿本组32例均和脾挫裂伤并存,为脾边缘线带状或新月形稍高密度影。
2.1.6 肾挫裂伤 本组6例,表现和脾挫裂伤相似。其中2 例为肾蒂断裂,表现为肾脏移位,旋转,肾门向前,腹膜后血肿。
2.1.7 胰腺损伤本组1例,为胰尾部横断,表现为胰尾明显增粗,密度增高,周围有高密度血肿。
2.1.8 消化道破裂 本组5例,小肠破裂2例,乙状结肠系膜损伤2,复合伤1 例,大网膜囊撕裂1例。2例表现为腹腔内的游离气体,常位于上腹腔间隙内,同时见少量积液。肠壁间血肿3例。, 百拇医药