高原肝脏枪弹伤致肺间接损伤的CT表现和病理对照研究  

Correlative study of CT and pathological findings in lungs following hepatic firearm injury at high altitude area

作　　者：王玮[1] 王劲武[2] 陈辉武[2] 陆洲[1] 蔡玲[1] 方向东[2] 刘洁[2] 刘斌[2] 赵耀[2] 

机构地区：[1]第四军医大学唐都医院放射科,西安710038 [2]西藏军区总医院放射科,拉萨800003

出　　处：《放射学实践》2004年第9期679-681,共3页Radiologic Practice

摘　　要：目的 :探讨高原肝脏枪弹伤所致肺间接伤的CT及HRCT表现及病理基础。方法 :高原适应猪 18只 ,分实验( 12只 )、对照 ( 6只 )两组。口径为 5 .80mm弹道枪造成猪肝脏贯通伤 ,行胸部CT及HRCT扫描 ,制作充气固定肺标本 ,病理大切片和常规病理切片 ,逐级对照相应表现。结果 :①CT示肺叶、段实变 ,以肺下野为主 ,上野以亚段、小叶实变多见 ;支气管血管束边缘模糊 ,周边肺野呈磨玻璃样改变 ;肺不张。②HRCT示肺小叶实变、气肿、磨玻璃样改变 ;小叶间隔、小叶核增厚、增粗。③HRCT所见征象均可在充气固定肺标本的HRCT扫描中显示。④病理大切片示肺泡腔、支气管血管束间隙可见水肿液和红细胞。⑤常规病理示肺微血管扩张、破裂 ,肺间质和肺泡腔内出血 ,并可见高蛋白、高渗出性水肿液。结论 :高原腹部枪弹伤肺间接伤以压力波直接作用和血流扰动波所致的出血、渗出为主 ;损伤可诱发高原肺水肿 ;CT可发现出血渗出所致的实变、不张 ;HRCT可在极早期发现肺小叶水平的变化。Objective:To study the CT and pathologic characteristics of the pulmonary injuries induced by hepatic firearm wounds.Methods:Eighteen pigs who acclimatized to high altitude were divided into 2 groups (12 for experiment,6 for control).Hepatic penetrating wound was made with 5.8mm ballistic trajectory gun.The CT and HRCT scan images of all chests were correlated with the corresponding histopathological finding.Results:The CT scan showed consolidation at the pulmonary lobe,segment or subsegment with atelectasis in some lobes.HRCT scan showed consolidation,emphysema in some lung lobules.Erythrocytes and serous extravasate could be seen in the peribronchial space and the alveoli.Some septa and vessel walls became swelling.Conclusion:Pulmonary edema following hepatic firearm wound at the high altitude areas was characterized by hemorrhage and exudation,which may be induced by the direct shock and the disturbed blood hydro- kinetic waves.CT scan is helpful in detecting the pulmonary atelectasis and consolidation caused by hemorrhage and exudation and HRCT scan can detect the pathologic changes of lung lobule in the early stage.

关 键 词：肝脏 枪弹伤 肺间接损伤 CT表现 病理学 创伤 体层摄影术 

分 类 号：R657.3[医药卫生—外科学]