不同病因腹膜后血肿的临床特点及影像诊断

目的探讨不同病因腹膜后血肿的临床特点与诊断。方法回顾性分析63例腹膜后肿,外伤性血肿组41例,术后腹膜后血肿组16例,非外伤性腹膜后血肿组6例。诊断主要是B超、腹穿和CT;比较各组血肿的发生部位、大小、动态变化、血压、临床主诉、误诊等。分析不同血肿的诊断、误诊率及原因。结果 18例外伤性腹膜后血肿有动态和血压的变化,其余23例则稳定。各组血肿部位、大小和临床症状相差不大。外伤组与术后组和非外伤组误诊率分别8%、32%、33%,前者与后两组相差显著（P〈0.05）。结论创伤组较其它组更易出现血肿动态增大和血压波动。后腹膜血肿要影像学动态观察,误诊原因主要是过分强调B超和腹穿而忽视了CT的作用。

Retroperitoneal haematoma in different etiologies: clinical characteristics and diagnosis.

Objective To investigate the diagnosis and clinical features on retroperitoneal hematoma caused by different etiologies.Methods Clinical data of 63 cases of retroperitoneal hematoma were studied retrospectively.41 of 63 cases were caused by trauma;16 of 63 were by post-abdomen operation and 6 cases with non-trauma and non-trauma history.The main tools to diagnosis these patients were ultrasound,abdominal puncture and CT scan;The size,location,changes,blood pressure,complains and the rate of misdiagnosis of Each lesions in different groups patient were been compared.Results 18 of 41 traumatic hematoma had dynamic changes both in volume and pressure.23 of 43 without any changes.The symptoms,signs,location,size in different groups had no significance.The rate of misdiagnosis were 8 %（traumatic group）,32 %（post-operation group）and 33 %（non-traumatic group）.There was significant difference between the rate of traumatic groups and that of other two groups（P0.05）.Conclusion Traumatic hematoma had a tendency of hematoma growth and pressure changes compared to other 2 groups.Retroperitoneal hematoma need dynamic observation.Causes of misdiagnosis was mainly because of over-estimating the role of ultra-sound and abdominal puncture and ignoring the role of CT scan.