延迟性脾破裂的超声诊断价值  

The diagnostic value of ultrasonography in delayed rupture of spleen

作　　者：刘谨[1] 吕仕银[2] 刘树辉[2] 

机构地区：[1]四川省大英县人民医院超声科,629300 [2]四川省大英县人民医院普外科,629300

出　　处：《中华医学超声杂志（电子版）》2010年第1期21-24,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨延迟性脾破裂(DRS)的超声动态声像图特征,提高诊断准确率。方法采用常规超声及彩色多普勒超声对23例临床诊断为DRS的患者进行检查,按照脾损伤病理解剖类型对患者的超声图像进行分类;随患者病情变化,对中央破裂、包膜下破裂、真性破裂3类脾损伤的超声图像进行动态观察,并与患者临床和手术治疗情况进行对照分析。结果 23例脾破裂患者术前超声诊断DRS与手术诊断符合20例,2例脾包膜下破裂保守治疗,超声动态观察病情变化至痊愈;脾包膜下破裂误诊为酒精性肝硬化伴少量腹水1例,手术中诊断为脾包膜下破裂。23例患者声像图表现:(1)中央破裂2例,脾脏肿大,包膜连续,实质部测及杂乱不均回声团块;超声动态观察中2例发展为真性破裂;(2)包膜下破裂5例(含超声误诊1例),4例包膜下破裂患者脾脏肿大,形态失常,包膜连续、隆起,包膜下测及低回声团块,3例见脾周少量积液;超声动态观察中2例发展为真性破裂;(3)真性破裂16例,包膜连续线中断或模糊,破裂部回声杂乱、呈不规则增强或减弱回声团块,其内可测及不规则无回声,16例均见腹腔积液。超声检查后手术治疗21例,保守治疗2例,23例DRS临床均治愈。结论 DRS患者发病迟、病情变化快,超声声像图随病情变化而改变,脾脏中央破裂、包膜下破裂可发展为真性破裂;须动态监测不同时段声像改变作出准确超声诊断,为临床诊治DRS提供超声影像学依据。Objective To investigate the ultrasonographic features of the delayed rupture of spleen （DRS） for improving the accuracy of diagnosis. Methods A total of 23 cases of DRS diagnosed by clinicians were examined with the conventional and color Doppler uhrasonography. The ultrasonographic characteristics of three types in splenic trauma were classified according to the pathologic anatomic classification including central rupture, subcapstular rupture and true rupture. According to the changes of ultrasonagraphic images and dynamic monitoring of lesions, the splenic trauma were contrasted to the results of clinical and surgical treatment. Results The 20 cases of DRS were corresponded to surgical diagnosis and conservative treatment for 2 cases of DRS diagnosed by ultrasonography （the results of treatment were observed in dynamic） , 1 case was misdiagnosed （which DRS was diagnosed by the operation while a little ascites and alcoholic cirrhosis was diagnosed by uhrasongraphy）. The results in 23 cases of patients were shown with ultrasound as follows： a. 2 cases of central rupture with spleen enlargement, capsule under the broken line envelop, renchymal enhancement in a disorderly and dimly manner, and 2 cases developing to true rupture under the dynamic observation of uhrasonography; b. 5 cases of subcapsular rupture （ contain the case of misdiagnosis） , 4 cases of subcapsular rupture with spleen enlargement, parenchymal enhancement in a disorderly and dimly manner or hypoechoic echo area and capsule under the broken line envelope with the protuberant envelope line, a little fluid around the spleen; 2 cases developing to true rupture in the dynamic observation under ultrasonography; e. 16 cases of true rupture with the capsular interrupted line or fuzzy and with the enhancement and hypo-echo of disorder and irregular or detectable the echo-free zone of central rupture, fluid in abdomen in the all of 16 cases. 21 cases with routine surgery, 2 cases with conservative treatment in the 23 cases of DRD. Conc

关 键 词：超声检查 延迟性 脾破裂 

分 类 号：R657.6[医药卫生—外科学]