16层螺旋CT诊断外伤性脾脏破裂的临床价值  

Clinical value of spiral CT in the diagnosis of traumatic rupture of spleen

作　　者：杨燕[1] 雷瑞美 

机构地区：[1]浙江省绍兴市人民医院放射科,浙江绍兴312000 [2]浙江省上虞市妇保院放射科,浙江上虞312300

出　　处：《医学影像学杂志》2013年第4期549-551,共3页Journal of Medical Imaging

摘　　要：目的探讨外伤性脾脏破裂的CT表现及其临床价值。方法对53例外伤性脾脏破裂患者行螺旋CT检查,其中35例平扫加增强三期扫描,13例直接增强扫描,5例平扫;并对其CT表现进行回顾性分析。结果 CT诊断脾脏破裂根据Gay分级:Ⅰ级:局限性包膜破裂及小的包膜下血肿,8例,非手术保守治疗;Ⅱ级:小的外周撕裂,实质内血肿<3cm,15例,其中3例选择性脾脏手术切除,12例非手术保守治疗;Ⅲ级:撕裂延伸至脾门及实质,血肿直径>3cm,25例,其中20例选择性脾脏手术切除,1例全脾手术切除,4例非手术保守治疗;Ⅳ级:脾脏粉碎及血管破裂,5例,全脾手术切除。结论外伤性脾脏破裂CT表现具有特征性,诊断的敏感性和准确性都较高,对临床分级及确定治疗方案有着重要的指导意义,从而得到合理的临床治疗,可作为脾脏外伤检查的首选方法。Objective To investigate the CT performance and its clinical value in the diagnosis of the traumatic rupture of spleen. Methods 53 patients with traumatic rupture of spleen underwent spiral CT examination, of which 35 were subjec- ted to plain and enhanced three-phase scan, 13 to direct enhanced scan, 5 to plan scan. The CT findings were retrospec- tively analyzed. Results CT diagnosis of spleen rupture was according to Gay grading. Grade I ： limitations of capsular rupture and small subcapsular hematoma. There were 8 cases in Grade I , which were subjected to conservative treat- ment; Grade II： small peripheral tear, intraparenchymal hematoma ~ 3 cm. There were 15 cases in Grade II, of which 3 cases were subjected to selective spleen operation and 12 cases to conservative treatment; Grade III.. laceration extending to the splenic hilum and essence of more than 3 em in diameter. There were 25 cases in Grade III, of which 20 were subjected to selective spleen operation, one to spleen excision operation, and 4 cases to conservative treatment; Grade IV~ spleen crushing and vascular rupture. There were 5 cases Grade IV, which were all subjected to splenectomy. Conclusion Trau- matic rupture of spleen has characteristic CT features, with high sensitivity and accuracy, which can be used as the pre- ferred method of spleen trauma inspection.

关 键 词：脾脏 破裂 体层摄影术 X线计算机 

分 类 号：R657.6[医药卫生—外科学] R814.42[医药卫生—临床医学]