多层螺旋CT增强扫描对肾损伤的诊断价值

目的探讨多层螺旋CT（MSCT）增强扫描在肾损伤中的诊断价值。 方法回顾性分析2012年1月至2017年12月间我院收治116例肾损伤患者的MSCT扫描和超声检查资料，其中增强扫描92例，延迟期扫描41例，比较二者在肾损伤临床分级诊断的符合率。 结果根据美国创伤外科协会肾损伤分级标准，对所有患者进行明确诊断和分级，本组116例患者中Ⅰ级26例，Ⅱ级27例，Ⅲ级39例，Ⅳ级14例，Ⅴ级10例；MSCT对Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级、Ⅴ级闭合性肾损伤的分级诊断符合率分别为88.5%、88.9%、89.7%、92.8%、100.0%，显著高于超声的诊断符合率80.7%、81.5%、84.6%、85.7%、90%，二者比较差异具有统计意义（P<0.05）。MSCT平扫有1例考虑右肾损伤行探查发现肾脏完整，而增强扫描与手术结果符合率100%。 结论MSCT增强扫描能快速明确患者肾损伤的程度及合并伤情况，对肾损伤诊断和分级具有重要临床指导价值。

Diagnosis value of multi-slice spiral CT in renal trauma

ObjectiveTo evaluate the diagnostic value and clinical significance of multi-slice spiral CT (MSCT) enhanced scanning in blunt renal trauma. MethodsThe clinical data of 116 patients with renal trauma treated in our hospital from January 2012 to December 2017 were analyzed. All of these cases underwent abdomen MSCT scans and 92 cases underwent enhanced scans, 41 patients performed excretory phase scan. The CT manifestations were analyzed, and compared with the B ultrasound results, the rates of diagnosis of kidney were compared. ResultsAccording to criterion of Association for the Surgery of Trauma (AAST), the 116 cases were divided intoⅠ-Ⅴ grades according to American Association for the surgery of trauma organ injury Severity Scale for the Kidney. Multi-slice spiral CT in the diagnosis of patients with renal injury in 26 cases of grade I, 27 cases of grade II, 39 cases of gradeⅢ, 14 patients of gradeⅣ, 10 cases of grade V. Diagnosis rates of spiral MSCT in classⅠ, gradeⅡ,Ⅲ,Ⅳ,Ⅴ level in renal closed injury rate were 88.5%, 88.9%, 89.7%, 92.8%, 100.0%, which was significantly higher than that of B ultrasound diagnosis coincidence rate 80.7%, 81.5%, 84.6%, 85.7%, 90%, the difference had statistical significance (P<0.05). The outcomes of MSCT enhanced scanning achieve a 100% diagnostic accuracy rate, which was confirmed by surgical findings. In one case of MSCT plain scan, right kidney injury was considered and renal integrity was detected by surgical exploration, while enhanced scan was 100% consistent with the surgical results. ConclusionMSCT enhanced scanning can quickly determine the degree of renal injury and the concomitant injury of patients, and has important clinical guiding value for the diagnosis and grading of renal injury.