可吸收网包裹创伤脾术后脾血流的超声造影观察  

Observation of the blood flow of absorbable mesh encapsulated traumatic spleen with contrast-enhanced ultrasound

作　　者：陶世明[1] 庄志浩[1] 吴岷翰[1] 卢彦川[1] 陈务民[1] 霍景山[1] 刘照宏[2] 

机构地区：[1]广东省佛山市中医院普通外科,528000 [2]广东省佛山市中医院超声诊疗科,528000

出　　处：《临床超声医学杂志》2013年第8期552-555,共4页Journal of Clinical Ultrasound in Medicine

基　　金：2010年度佛山市科技攻关项目(201008048)

摘　　要：目的超声造影观察可吸收网包裹创伤脾术后脾的血流情况,以探讨可吸收网包裹保脾的价值。方法Ⅲ、Ⅳ级脾破裂患者30例,15例行常规手术切除脾脏为切脾组,15例以可吸收微乔网片缝合包裹破裂脾为保脾组;术后第1,2周常规超声和超声造影观测脾脏总面积和显影面积,并检查两组患者血IgG、IgM、CD4、CD8水平。结果术后第1,2周,保脾组超声显示保留的活性脾组织血流信号丰富。超声造影显示脾脏面积均较常规超声显示脾脏面积减小(P<0.05)。与术后第1周比较,术后第2周常规超声和超声造影显示脾脏面积均减小(P<0.05);而超声造影显示脾脏面积占常规超声显示脾脏面积的比率差异无统计学意义(P>0.05)。与切脾组比较,保脾组较术后第1,2周IgM和第1周CD4均增高(P<0.05)。30例脾破裂患者均治愈。结论超声造影是观察保脾术后脾血流的最佳方法。微乔网包裹保脾是一种安全、有效的保脾方法,能最大限度地保留脾组织和脾脏的免疫功能;保留的脾脏血流灌注良好。Objective To investigate the value of absorbable mesh in protecting spleen by observing the blood flow of traumatic spleen with contrast-enhanced ultrasound （CEUS）. Methods Thirty patients with grade Ⅲ- Ⅳ spleen rupture were included. 15 patients who underwent routine operation of spleen excision were divided into spleen excision group. 15 patients with spleen encapsulated by absorbable mesh were divided into spleen reserve group. Conventional ultrasound and CEUS were applied to record the splenic general area and the contrast-enhanced imaging area 1 and 2 weeks after the operation. The IgG, IgM, CD4 and CD8 were detected 1 and 2 weeks after the operation. Results One and 2 weeks after the operation, CEUS showed abundant blood flow signals in the spleen in spleen reserve group. The splenic area measured by CEUS was smaller than that measured by conventional ultrasound （P〈0.05）. Compared with 1 week after operation, the splenic area measured by conventional ultrasound and CEUS was decreased 2 weeks later （P〈0.05）. the ratio of splenic general area and splenic imaging area had no significant difference （P〈0.05）. Compared with spleen excision group, the IgM was increased 1 and 2 weeks later and CD4 was increased 1 week later（P〈0.05）. 30 cases were all cured. Conclusion CEUS is the best way to observe the splenic blood flow after spleen reserve surgery. Protecting spleen encapsulated with absorbable mesh is a safe and effective method, which can maximize the retention spleen tissues and immune function of spleen; keep good splenic blood perfusion.

关 键 词：超声检查 造影剂 脾破裂 创伤性 保腺 可吸收网 

分 类 号：R657.62[医药卫生—外科学] R445.1[医药卫生—临床医学]