肝破裂伤迟发性并发症的诊断与治疗  

Delayed Complications of Hepatic Rupture:Imaging Diagnosis and Treatment

作　　者：王仁贵[1] 高玉洁[1] 蒋学祥[1] 山元章生 蒲永林 

机构地区：[1]北京大学第一医院医学影像科,北京100034 [2]日本佐贺县伊万里市山元外科病院 [3]北京大学第二医院医学影像科

出　　处：《实用放射学杂志》2002年第12期1054-1057,共4页Journal of Practical Radiology

摘　　要：目的　回顾性总结肝破裂伤迟发性并发症的MR和CT诊断和治疗。方法　 2 0例肝破裂伤患者中有 8例于术后 1～ 3周合并迟发性合并症。 7例行经皮肝穿引流 ,1例行剖腹再修补术 ,预后良好。治疗前后所有患者均行MRI和CT检查。结果　 8例迟发性合并症包括复发性出血 3例、胆汁瘤 3例和肝脓肿 2例。其中胆汁瘤、肝脓肿和肝内再出血灶在T1WI呈特征性的“双向”信号改变 ,而在T2 WI和CT图像上分别为非特异性的高信号和低密度影。结论　磁共振T1WI对判断恢复期肝内血肿的愈合和迟发性合并症的诊断优于T2 WI和CT扫描。迟发性合并症的发生与肝内大血管或胆管受损密切相关 ,有必要对深破裂伤患者在受伤 1月内复查MRI或CT。经皮肝穿引流对胆汁瘤和肝脓肿疗效较好 。Objective To retrospectively evaluate the MR and CT features of delayed complications of hepatic rupture and clinical management.Methods Delayed complications developed in 8 of 20 patients with hepatic rupture 1～3 weeks after surgery.7 patients were managed with PTD and one with laparotomy.MRI and CT were followed-up before and after treatment.Results Delayed complications included 3 bilomas,3 recurrent bleedings and 2 abscess,which appeared characteristic bi-directional changes of the signal intensity on T 1-weighted image and were non-specific on T 2-weighted image(hyperintense)and CT (low-density).Conclusion T 1-weighted images appeared to be more effective than T 2-weighted images and CT in the differentiation of delayed complications from subacute intrahepatic hematoma.Followed-up MRI and CT are needed in patients with deeptype hepatic rupture in the first month after injury.PTD and laparotomy are helpful in management of biloma and abscess and nonuseful in patient with inactive recurrent bleeding.

关 键 词：肝脏外伤 迟发性合并症 体层摄影 X线计算机 磁共振成像 

分 类 号：R657.33[医药卫生—外科学]