腹部钝性伤致肾蒂损伤后肾梗死的MSCT特征分析  

Blunt abdominal injury induced by injury of renal pedicle renal infarction after analysis of characteristics of MSCT

作　　者：王富泉[1] 蔡艳伟[1] 

机构地区：[1]河北钢铁集团有限公司承钢公司职工医院,河北067002

出　　处：《中国伤残医学》2014年第14期17-19,共3页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的：探讨腹部钝性伤后单纯肾蒂损伤后的 MSCT特征。方法：回顾性分析腹部钝性伤后经CT检查，临床随访，手术证实，其他影响检查互相印证的肾损伤40例，其中肾蒂损伤2例，占肾损伤5％，肾动脉分支损伤2例，占肾损伤的5％，所有患者均行MSCT平扫及增强扫描。结果：肾蒂损伤后MSCT表现：（1）腹腔积血；（2）膈肌脚增厚及膈肌脚浸润征象；（3）膈后间隙片状出血；（4）伤后1∽12小时肾轮廓、大小、密度、形态未见异常、肾周围脂肪囊清晰；（5）伤后24小时肾前、肾后筋膜稍增厚，肾周脂肪囊条索状影；（6）伤后3天以后肾体积进一步增大，密度减低，肾周脂肪囊片絮状影，肾筋膜增厚，膈后间隙及膈肌脚积血量未增加，均在肾内侧，未见肾外侧积血；（7）增强扫描可见肾血管内造影剂外溢及肾灌注减低和肾无灌注，可出现肾节段性及全肾梗死，肾皮质呈“线状强化的皮质环征”；（8）合并肠系膜血管损伤及肠管挫伤。结论：肾蒂损伤后早期出血较特征性位于肾内侧，主要位于膈肌脚及膈后间隙，可合并肠系膜血管及肠管损伤，及早增强扫描可发现肾灌注情况，为临床选择合适的治疗方案提供影像学依据，外科医师在作肠道修复手术时应注意避免过分牵拉，引起肾蒂进一步损伤。Objective：To study the simple renal pedicle injury after blunt abdominal injury after MSCT features .Methods：After blunt abdominal injury were retrospectively analyzed by CT examination , clinical follow-up, surgery confirmed that other effects inspection to confirm each other 40 cases of renal injury , including 2 cases of renal pedicle and accounted for 5%of kidney damage renal arterial injury in 2 cases, accounting for 5%of the kidney damage , all patients were performed MSCT scan and enhanced scan .Results：After injury of renal pedicle hemoperitoneum MSCT performance： （ 1 ） , （ 2 ） thickening and diaphragm diaphragm the feet infiltrating signs , （ 3 ） the clearance sheet after bleeding , （4） 1-12 h after injury of renal contour , shape, size, density did not see abnormalities , renal adipose capsule around the clear, （5） after the injury after 24 h before the kidney, renal fascia slightly thickened, week renal adipose capsule a funicular , （6） after 3 days after injury kidney volume increased further , density decreased , renal adipose capsule flocculent shadow , zhou renal fascia thickening , diaphragmatic after clearance and diaphragm foot HP did not increase , both in the renal inside , no kidney laterally hemorrhage, （7） enhanced scanning contrast agents within the visible renal vascular and renal perfusion reduction and renal perfusion , could appear renal segmental and complete renal infarction , renal cortex showed linear strengthening ＆quot;cortical ring sign＆quot;（8） merger and bowel mesenteric vascular injury contusion .Conclusion：Early bleeding after renal pedicle injury should be characteristic medial to the kid -ney, mainly in the diaphragm and diaphragm foot clearance , after merger of mesenteric vascular and bowel lesions , enhanced scan could be found as early as possible renal perfusion , provide imaging basis for clinical choice suitable treatment , surgeons in excessive force should be paid attention to when the intestinal surgery to repair , to

关 键 词：钝性伤 肾蒂 出血 体层摄影术 X线计算机 

分 类 号：R656[医药卫生—外科学]