多层螺旋CT增强表现对肝动脉损伤的诊断及预后的预测价值  

Predictive value of MSCT in the diagnosis and prognosis of hepatic arterial injuries

作　　者：李然 高天虎 范晓黎 王璐 Li Ran;Gao Tianhu;Fan Xiaoli;Wang Lu(Department of Radiology,Banan Hostipal of Chongqing Medical University,Chongqing 401320,China;Department of Radiology,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]重庆医科大学附属巴南医院放射科,重庆401320 [2]陆军军医大学大坪医院放射科,重庆400042

出　　处：《创伤外科杂志》2022年第12期908-913,共6页Journal of Traumatic Surgery

基　　金：重庆市巴南区科技局社会事业与民生障碍科技专项项目(2020-25)。

摘　　要：目的评价肝脏损伤中动脉损伤的CT表现,并探讨其与患者治疗方式及预后的关系。方法回顾性研究2015年5月—2021年12月重庆医科大学附属巴南医院和陆军军医大学大坪医院创伤中心收治的共74例肝脏损伤患者的影像资料和临床资料,包括患者的年龄、性别、住院时间、致伤原因、损伤类型及有无行手术治疗、介入治疗和输血等,在增强CT上判断肝脏是否存在动脉损伤并按照2018年美国创伤外科协会(American Association for the Surgery of Trauma,AAST)的标准进行分级。采用统计描述、Logistic回归等统计方法对数据进行分析,评价肝脏动脉损伤与治疗方式和临床预后的相关性。结果74例肝脏损伤患者中,男性54例,女性20例;年龄13~64岁,平均39.1岁;损伤类型:钝挫伤41例,穿透伤33例;致伤原因:锐器伤19例,道路交通伤31例,高处坠落伤12例,重物砸伤12例;平均住院时间19(15,28)d,平均收缩压(117.2±21.6)mmHg,平均脉搏(71.7±13.4)次/min。74例患者中,14例为重度肝损伤(AASTⅣ~Ⅴ级),其中10例有动脉损伤;60例为轻度肝损伤(AASTⅠ~Ⅲ级),其中有4例动脉损伤。14例动脉损伤患者与无动脉损伤患者相比,其住院中位数时间延长了16d(P<0.001),接受肝动脉栓塞术的概率增加了17倍(P=0.003)。重度肝损伤患者非手术治疗失败的概率是轻度肝损伤患者的5.3倍。结论动脉损伤在肝损伤中并不少见,多层螺旋CT增强检查有助于预测患者的预后和治疗方式。Objective To evaluate the CT findings of combined arterial injury in liver injuries and to explore the relationship between arterial injury and treatment options as well as prognosis.Methods The imaging and clinical data of 74 patients with liver injuries treated in Banan Hospital of Chongqing Medical University and the Trauma Center of Daping Hospital of Army Medical University from May 2015 to Dec.2021 were collected,including age,sex,length of hospital stay,injury mechanisms and types,treatment options(surgery,interventional therapy,blood transfusion,etc.),and outcomes.The presence of arterial injury in the liver was determined by using enhanced CT and graded according to the 2018 American Association of Trauma Surgeons(AAST)criteria.Statistical description and Logistic regression were used to analyze the data to evaluate the correlation between hepatic artery injury and treatment options as well as clinical prognosis.Results Among the 74 cases of liver injuries,there were 54 males and 20 females,aged 13-64 years,mean 39.1 years.There were 41 blunt and 33 penetrating injuries with the injury mechanisms being sharp instrument injuries in 19,road traffic crashes in 31,falls from height in 12,and hit by heavy objects in 12 cases.The median length of hospital stay was 19(15,28)d,mean systolic blood pressure(117.2±21.6)mmHg,and pulse(71.7±13.4)beats/min.Of the 74 patients,14 were of high-grade(AAST grade IV-V),including 10 arterial injuries;and 60 cases were of low-grade(AAST grade I-III),with 4 arterial injuries.The 14 patients with liver arterial injuries showed a much longer median length of hospital stay(16 d longer than that of those without arterial injuries,P<0.001),and the probability of receiving hepatic artery embolization was 17 times higher(P=0.003).Moreover,the risk of surgical failure was 5.3 times higher in patients with high-grade liver injuries than in those with low-grade liver injuries.Conclusion Arterial injury is not uncommon in liver injuries.Enhanced MSCT is helpful to predict the prognosis

关 键 词：腹部创伤 多层螺旋CT 动脉损伤 肝脏 

分 类 号：R657.3[医药卫生—外科学] R816.5[医药卫生—临床医学]