肺撕裂伤的CT分型及临床意义  

CT classification of lacerating lung injury and its clinical significance

作　　者：彭梦明 唐肇普[2] 钱新初 刘三军 董榕波 熊南山 

机构地区：[1]解放军第四五七医院影像诊断科,武汉430012 [2]第三军医大学附属大坪医院影野战外科研究所像诊断科

出　　处：《中华创伤杂志》2009年第6期493-495,共3页Chinese Journal of Trauma

摘　　要：目的探讨闭合性胸外伤中肺撕裂伤的CT分型及临床意义。方法将63例肺撕裂伤据CT表现分为单纯型肺撕裂伤（脏层胸膜完整，无气胸或血气胸征）和复杂型肺撕裂伤（伴有脏层胸膜破裂，有气胸或血气胸征）两组，并对其CT与临床资料进行回顾性比较分析。结果63例中，脏层胸膜完整的单纯型肺撕裂伤35例（56％），多为肺边缘局灶性肺假性囊肿病灶，无并发症，均经保守治疗后消散快，平均住院16d。伴有脏层胸膜破裂的复杂型肺撕裂伤28例（44％），肺内损伤范围较大，伴有肺挫伤20例（71％），并发肺膨胀不全或肺不张15例（54％），局部肺感染3例（11％），行胸腔穿刺或闭式引流19例（69％），开胸手术1例（4％），平均住院58d。结论肺撕裂伤据CT表现是否伴有脏层胸膜破裂可分为单纯型肺撕裂伤和复杂型肺撕裂伤，CT分型诊断对临床治疗方案的选择和预后的早期判断有帮助。Objective To explore the CT classification of lacerating lung injury in blunt thoracic trauma and its clinical significance. Methods A total of 63 patients with lung lacerating injury were classified using CT features as simple type injury （ complete visceral pleura, with no pneumothorax or hemopneumothorax） and complex type injury （accompanied by visceral pleura rupture, pneumothorax or hemopneumothorax ）. A retrospective analysis was done on CT manifestations and clinical data. Results Of 63 patients, 35 patients （ 56% ） had simple type of lacerating lung injury with complete visceral pleura, most of which were focal pulmonary pseudocyst lesions present in the edge of lungs and could be dis- persed quickly after conservative therapy without complications. Mean hospital stay was 16 days. Of pa- tients with complex type of lacerating lung injury, 28 patients （44.4%） were accompanied by visceral pleura rupture with larger extent of pulmonary injury, 20 （71%） by lung contusion, 15 （54%） by atelectasis or pulmonary atelectasis and three （ 11% ） by local pulmonary infection. Thoracic puncture or closed drainage was performed in 19 patients （69%） and thoracotomy in one （4%）, with mean hospital stay of 58 days. Conclusions According to CT manifestations on whether there exists visceral pleura rupture or not, the lacerating lung injury is classified as simple type injury and complex type injury. CT classification of lacerating lung injury may be helpful in selecting clinical treatment protocols and predicting early prognosis.

关 键 词：肺 撕裂伤 体层摄影术 X线计算机 损伤分型 

分 类 号：R655.3[医药卫生—外科学] R651.15[医药卫生—临床医学]