腹部闭合性创伤的急诊CT评价

目的：探讨急诊CT扫描在腹部闭合性创伤中的应用价值。方法：收集整理经手术或临床证实的腹部闭合性创伤65例急诊CT检查的影像资料,进行回顾性分析,所有病例均行CT平扫。结果：腹部闭合性创伤的急诊CT扫描主要表现为混杂高密度影像,多伴腹腔出血。本组65例腹部闭合性创伤中,肝脏损伤15例、脾26例、肾13例,肠系膜与肠管损伤2例,膀胱破裂2例,复合性实质性脏器损伤7例。其中51例伴腹腔出血,22例合并肋骨骨折。结论：急症CT扫描对诊断腹部闭合性创伤具有很大的价值,能明确腹部脏器损伤的部位、程度及复合性脏器损伤等信息,以指导临床医师制定有效的治疗方案。     

闭合性腹部外伤的CT诊断价值（附85例分析）

目的:评价CT检查对闭合性腹部外伤的诊断价值.材料和方法:回顾性分析85例闭合性腹部外伤的CT表现.结果:闭合性腹部外伤以实质性脏器为多,脾损伤45例、肾损伤20例、肝损伤12例、复合伤 7例、外伤性膈疝1例.其中外伤后肝癌破裂出血1例.平扫加增强45 例.结论:CT扫描可对闭合性腹部外伤作出正确诊断,并为临床治疗提供重要信息.     

闭合性腹部实质脏器损伤的CT评价

目的:探讨腹部实质脏器损伤的CT表现及临床价值。方法:回顾性分析120例闭合性腹部实质脏器损伤的CT表现。结果:单脏器损伤113例,包括肝损伤16例,脾损伤51例,肾损伤43例,胰腺损伤3例;多脏器损伤7例,包括肝损伤伴右肾损伤1例,肝损伤伴脾损伤2例,脾损伤伴左肾损伤3例,脾损伤伴胰腺损伤及左肾盂输尿管连接处损伤1例。腹部实质脏器损伤的CT表现包括挫伤、撕裂伤、实质内血肿及被膜下血肿。首次CT平扫漏诊肝撕裂伤1例,脾损伤3例,肾撕裂伤2例,左肾盂输尿管连接处损伤1例。结论:CT检查可早期准确诊断腹部实质脏器损伤,为临床治疗提供重要依据。     

闭合性腹部创伤的CT诊断与评价

闭合性腹部创伤造成脏器损伤是比较常见的,由于临床上对患者的伤情难以估量,使治疗产生困难。CT扫描对脏器损伤的程度和范围能较准确地作出诊断,为抢救和治疗起到了一定的作用。为此,我们在十几年中共收集了128例闭合性腹部创伤的病例,进行回顾性分析,并重点讨论CT平扫表现及其价值。1资料与方法本组闭合性腹部创伤128例中,男77例,女51例,年龄13~72岁,平均36岁。其中,车祸75例,高空坠落伤24例,被打及牛角顶伤16例,重物撞击伤及塌方致伤13例。肝脏损伤38例,脾脏损伤47例,肾脏损伤21例,胰腺损伤2例,肠管损伤11例,膀胱损伤9例。临床表现除受…     

腹腔实质脏器损伤B超与CT检查比较分析

目的：比较腹腔实质脏器损伤B超与CT的诊断在价值。方法：本文分析24例腹腔实质脏器损伤患者的B超和CT检查结果。并对CT表现和B超显示结果进行了比较分析。结果：B超CT用于检查腹部闭合伤时均有较高的敏感性和准确性。B超检查方便、快捷、可多体位、多切面、多次反复检查,是检查腹腔实质脏器闭合性损伤首选检查方法。当B超疑有腹部实质脏器损伤时,再行CT增强扫描以明确损伤范围和程度,为临床治疗提供依据。结论 ＣＴ和Ｂ超相结合可提高腹腔实质脏器损伤诊断准确率,为临床治疗提供依据。     

B超与多层螺旋CT诊断急诊腹部创伤临床价值分析

目的探讨B超与CT用于急诊腹部创伤诊断临床价值差异。方法分析我院收治急诊腹部创伤患者132例的B超与CT影像学检查资料,比较两种影像学方式脏器损伤及损伤程度分级诊断临床符合率。结果 B超和CT用于急诊腹部创伤患者脏器损伤及损伤程度诊断临床符合率比较差异无统计学意义(P0.05)。结论 B超与CT检查急诊腹部创伤诊断诊断均具有较高临床应用价值,其中B超因价格低廉、无辐射及可行床边检查等优势可作为首选诊断方法。     

CT对腹部钝伤的诊断价值与限度

目的：探讨CT对腹部钝伤的诊断价值与限度。方法：应用CT扫描对42例胳部钝伤患者进行了检查。结果：CT扫描发现肾外伤19例,肝外伤5例,脾外伤19例,肠系膜血肿2例,肠穿孔2例,其中有5例为复合伤。CT扫描能清楚地显示脏器损伤及胳腔出血的程度和范围。结论：CT能迅速、准确地检出腹腔脏器损伤,为临床选择治疗方法提供重要依据。     

胰腺及肾上腺闭合性损伤的CT诊断

目的:探讨腹部闭合性外伤所致胰腺及肾上腺损伤的CT表现特征,评价CT的应用价值。方法:回顾性分析23例经手术或随访证实的闭合性腹部外伤致胰腺及肾上腺损伤的临床与CT检查资料。结果:胰腺损伤19例,其中颈体部断裂11例,体尾交界部、胰头胰体部分断裂各3例,胰腺挫伤2例,主要表现为胰腺血肿,胰腺裂隙样或条状低密度影及外伤性胰腺炎改变。肾上腺损伤4例,均位于右侧,主要CT表现肾上腺区血肿,脂肪间隙模糊,其内可见条状高密度影。合并多脏器损伤8例。结论:CT能较准确的反映胰腺及肾上腺的损伤病理解剖改变,特别是胰腺断裂等重症患者,为临床制定治疗方案和疗效观察提供可靠的依据。     

CT平扫对肠及肠系膜损伤诊断价值探讨

目的探讨CT平扫在肠及肠系膜损伤诊断中的实际应用价值。方法回顾分析经手术或临床证实的53例腹部闭合性损伤中肠及肠系膜损伤病例的临床资料及CT平扫表现。结果 CT平扫主要定性诊断征象包括:腹腔积气17例;腹膜后积气1例;腹腔积液积血39例;肠壁增厚31例;肠系膜渗出及血肿17例;肠管扩张4例。37例CT平扫提示损伤部位,其中21例与手术或临床最终诊断结果一致。结论 CT平扫能对腹部闭合性损伤中肠及肠系膜损伤作出准确诊断。     

超声对闭合性腹部实质性脏器损伤的诊断价值

目的探讨闭合性腹部实质性脏器损伤的超声诊断价值。方法应用东芝340型和西门子X300型彩色超声诊断仪,对55例闭合性腹部实质脏器损伤的临床诊断资料进行回顾性分析。结果 55例患者中肝脏损伤12例,其中轻度裂伤6例,浅表裂伤4例,实质裂伤2例。脾脏损伤33例,其中轻度挫伤6例,实质深部血肿5例,包膜下血肿7例,完全性损伤15例。肾脏损伤10例,其中肾挫伤5例,包膜下裂伤3例,粉碎伤及肾蒂伤2例。结论超声诊断闭合性腹部实质脏器损伤既简便、经济、快速有效又可动态的观察损伤部位的严重程度。既对外科临床医师决定是否急诊手术治疗有重要的意义,又是对小的血肿及范围较小包膜下血肿非手术治疗过程中的随访也有一定的价值。     

闭合性腹部外伤致胰腺损伤的CT诊断(附15例报告)

目的:评价CT对闭合性腹部外伤所致胰腺损伤的临床诊断价值。方法:回顾性分析15例经手术证实的闭合性腹部外伤所致胰腺损伤的CT征象。结果:15例闭合性腹部外伤所致胰腺损伤中,胰腺挫伤5例,胰腺完全性断裂6例,胰腺不完全性断裂1例,胰腺出血3例。胰腺内出血、水肿,胰腺增粗是胰腺挫伤的直接征象;胰腺外形不连续、平扫或增强时垂直胰腺长轴的低密度、线条状影是胰腺断裂的直接征象。胰周积液、网膜囊积血积液,肾前筋膜增厚,腹腔积液是胰腺损伤的间接征象。结论:CT检查对胰腺损伤的诊断价值较大,CT增强比平扫更能明确胰腺的断裂;CT检查对于主胰管的断裂的诊断价值有待进一步研究。     

CT对儿童急性颅脑外伤的诊断价值及合理应用

目的 探讨CT检查对儿童急性颅脑外伤的诊断价值及合理应用。方法 回顾性分析702例儿童急性颅脑外伤的CT检查结果，按有无损伤及损伤部位分类。结果 702例患儿，447例CT平扫未见异常，占63.68%；单纯头皮血肿79例，占11.25%；颅骨损伤（不伴颅内损伤）132例，占18.80%；颅内损伤44例，占6.27%。结论 对于颅脑外伤患儿，CT检查难准确诊断颅脑损伤，但阳性率偏低，因此，CT检查是颅脑损伤的首选检查方法，但不应作为颅脑外伤的常规检查方法，应根据小儿颅脑外伤后的临床症状和体征，决定是否需要CT检查，而不能滥用。     

腹部脏器损伤的CT诊断

目的：介绍腹部实质性脏器损伤中的CT诊断作用及其表现。材料和方法：42例腹壁损伤合并内脏损伤者，其中30例为单一脏器损伤，12例为多脏器损伤。受伤脏器分别为脾15例、肝8例、肾7例、胰2例．全部病例均在受伤后8小时内进行CT平扫检查。结果：CT易发现腹内实质脏器不同类型破裂和不同程度出血。对并发的腹壁、腹腔及后腹膜腔、脊柱、肋骨等损伤也能同时检出。结论：CT对腹部实质性脏器损伤是一种高效、迅速、方便、准确的检查方法，对确定手术方案更是必须的。     

Gallbladder blunt trauma: comparison between radiologic and anatomo-surgical findings

PURPOSE: To assess the diagnostic accuracy and the possible role of ultrasonography (US) and Computed Tomography (CT) in a small group of patients who had a blunt abdominal trauma involving the gallbladder. MATERIAL AND METHODS: We retrospectively reviewed the US and CT findings of five patients with surgically confirmed post-traumatic gallbladder injury. The whole series consisted of 196 consecutive patients submitted to laparotomy for blunt abdominal trauma in the past 7 years. The following US and CT findings were considered at least suggestive of a possible post-traumatic gallbladder injury: pericholecystic fluid collection, ill-defined wall margin, collapsed lumen, high intraluminal density. RESULTS: At surgery, the following findings were observed: gallbladder hematoma (1 case), acute colecystitis (1 cases), gallbladder tear (3 cases), gallbladder tear associated with post-traumatic hepatic injuries (2 cases), duodenal tear (2 cases), hemoperitoneum alone (2 cases), hemoperitoneum associated with choleperitoneum (1 case), choleperitoneum alone (1 case). The US and CT findings were pericholecystic fluid collections (4 cases), ill-defined gallbladder wall margins (3 cases), collapsed lumen with intraluminal high density (1 case) and free intraperitoneal fluid collections (4 cases). They were suggestive of a possible post-traumatic gallbladder injury in all the five patients. CONCLUSIONS: The radiologic findings of our five patients were suggestive of a gallbladder damage but did not permit to distinguish minor from major injuries, the latter requiring surgical treatment. US proves to be a useful screening tool which can also help timing surgery in these patients. CT confirmed the US suspicions and also permitted accurate assessment of associated post-traumatic injuries to the liver and duodenum. Nevertheless, the clinical presentation was the most important factor as to the therapeutic management of these blunt abdominal trauma patients.     

螺旋CT与传统CT在急性闭合性腹外伤中应用的对比分析

目的:比较螺旋CT与传统CT在急性闭合性腹外伤中的应用价值。材料与方法:回顾性地对比了78例闭合性腹外伤病例,其中45例行传统CT扫描,33例行螺旋CT扫描。结果:螺旋CT的正确诊断率为90.9％(30例/33例),而传统CT的正确诊断率仅为80％(36例/45例)。同传统CT比较,螺旋CT不仅正确诊断率较高,而且扫描时间较短,图像质量较好(p<0.05)。除此之外,螺旋CT特有的丰富的后处理功能对闭合性腹外伤的诊断亦非常重要。结论:螺旋CT在闭合性腹外伤的诊断中,明显地优于传统CT,因此,如条件许可,应尽量选用螺旋CT检查。     

腹部创伤的CT诊断(附98例分析)

目的：为了对腹部创伤病人的临床治疗提供有用信息，回顾性分析了９８例腹部创伤病人的ＣＴ表现。方法：全部病例均作了ＣＴ扫描，范围从膈顶至肾脏下极。结果：腹部创伤以实质脏器撕裂伤和挫伤为多，其次为包膜下血肿及实质内血肿。腹膜后血肿往往合并于肾脏损伤。腹腔积血主要分布于肝脾周、双侧结肠旁沟、Ｍｏｒｉｓｏｎ囊。经增强扫描证实肝左动脉及左肾动脉损伤各１例。结论：ＣＴ扫描对于确定损伤脏器、腹腔积血量及腹膜后血肿定位极为准确，可为临床诊断和治疗提供重要信息。     

腹部闭合性损伤致肠和肠系膜损伤的CT平扫诊断

目的 探讨CT平扫在腹部损伤中肠道和肠系膜损伤的诊断价值.资料与方法 对115例经手术证实的肠道和肠系膜损伤患者的CT表现进行回顾性分析. 结果主要CT征象:(1)腹腔游离气体:共86例(74.8%).(2)腹腔和肠间隙积液、积血:共74例(64.3%).(3)肠壁水肿、增厚:共71例(61.7%).(4)肠系膜渗出、血肿:共78例(67.8%).结论 CT平扫对腹部闭合性损伤所致肠道和肠系膜损伤有重要诊断价值.     

隐匿性外伤性肠破裂的CT诊断

目的 探讨隐匿性外伤性肠破裂的CT表现,以提高对该病的诊断水平.方法 对11例手术证实的隐匿性外伤性肠破裂CT表现进行回顾性分析.结果 主要特异性CT征象有:(1)游离气体,共4例,位于外伤处小肠周围、膈下、腹膜后间隙,或位于包块内各l例;(2)肠间隙血肿或肌壁间高密度血肿(4例);(3)肠壁损伤征,受累肠肇局部低密度影,增强扫描强化局限性减弱,相邻肠管强化相对增强(3例);(4)外伤处小肠及周围包块(4例),增强扫描该包块有明显环形强化,延迟扫描有进一步强化.其他征象有:(1)腹腔及肠间隙积液(5例),周围脂肪间隙或肠间隙模糊改变(8例);(2)肠梗阻(11例).结论 CT对诊断隐匿性外伤性肠破裂钉重要诊断价值.     

Liver trauma due to penetrating lesions: miscellanea, personal case series, clinical and CT findings

PURPOSE: Penetrating liver wounds are related to many causes and rank second after blunt abdominal and liver trauma. We will report the clinical and radiological findings of our personal series of patients with penetrating trauma, especially by firearms and stab and cut wounds. We will also try to define the diagnostic workup of these traumas, which is especially based on CT signs of liver damage and associated changes and which is of basic importance for following treatment, both surgical or conservative. MATERIAL AND METHODS: In the last seven years we retrospectively reviewed 31 cases of penetrating liver trauma. The patients were 19 men and 12 women, ranging in age 18 to 73 (mean 42), with penetrating liver injuries from firearms (16 patients) and stab (9 cases) wounds; 6 patients had injuries from different causes. Abdominal CT was carried out in emergency with the CT Angiography (CTA) technique in all patients. In the patients with suspected chest and abdomen involvement CT was performed from the mid-chest for accurate assessment of diaphragm and lung bases and to exclude associated pleuropulmonary damage. RESULTS: Penetrating liver wounds were caused by firearms in 70% of cases, by stabbing in 12% and, in the extant 18%, by other causes such as home accidents, road and work traumas, and liver biopsy. In our series, the liver was most frequently involved, especially by firearms wounds; in our 16 cases the most frequent injuries were hemorrhagic tears. We found bullets in the liver in 6 cases. In one case of home accident the patient wounded himself while slicing bread with a long knife, which cut into the anterior abdominal wall and tore the anterior liver capsule, as seen at CTA. DISCUSSION AND CONCLUSIONS: Penetrating wounds to liver and abdomen are less frequent than those to the chest. In the past decade the use of CT has changed the diagnostic and therapeutic approach to such injuries completely, decreasing the resort to explorative laparotomy and hepatorrhaphy. Indeed, CT provides a clear picture of the extent and severity of damage, which permits to choose a conservative treatment in case of intraparenchymal hematomas and lacerocontusive foci without hemoperitoneum, which can be followed-up with physical and CT examinations. Moreover, Helical CT could provide the early diagnosis of active bleeding in the peritoneum and of focal bleeding in the liver, thus permitting prompt hepatorrhaphy or targeted hepatectomy. A diaphragm injury suspected at CT should always prompt the surgeon to intervention, especially when hemothorax, lung base pneumothorax, large liver hematoma or tear of the liver dome are associated. Finally, subdiaphragmatic free gas indicates gut perforation associated with liver damage, in which case surgery is necessary too.