部分性脾栓塞术治疗外伤性脾破裂的疗效和经验

目的　分析经皮穿刺部分性脾栓塞术 (PSE)治疗外伤性脾破裂的止血效果和临床经验。方法　 34例经超声、CT和腹腔穿刺证实为闭合性外伤性脾破裂病人。采用Seldinger技术 ,将 5FCobra 2导管经右侧股动脉插至脾动脉 ,行DSA检查 ,对出血的部位、范围和严重程度等进行评估 ,然后超选择插管至出血动脉 ,经导管注入 2mm× 2mm× 2mm或 2mm× 2mm× 10mm大小的明胶海绵颗粒 (条 ) ,栓塞破损血管。于右下腹麦氏点处 ,经皮穿刺置入 8F“猪尾”多侧孔引流管 ,引流腹腔积血。确认无污染、无溶血者 ,行积血回输。于PSE后 7、14d对全部病例作血常规和脾脏超声检查。并在术后 7(7例 )、14 (7例 )、30 (7例 )、6 0 (7例 )和 90 (6例 )d行脾脏CT扫描。结果　本组病例全部止血成功 ,技术成功率和止血有效率均为 10 0 %。 17例行腹腔积血自体回输 ,平均回输血量 (6 6 0± 190 )ml(4 0 0～ 16 0 0ml)。PSE后 3～ 7d拔除引流管 ,平均住院日 (7± 2 .3)d(4～ 14d)。CT随访显示 :术后 7d脾脏体积增大 ,PSE区密度减低 ,与被栓塞动脉的供血范围一致 ,腹腔积液明显减少或消失。 14d显示梗死区密度进一步减低 ,与周围脾组织境界清楚。 30d脾体积缩小 ,外形不规则 ,呈波浪状。 6 0～90d ,脾外形进一步缩小 ,轮廓呈分叶状 ,脾实质密度     

Radiologic investigation of splenic trauma

The radiologic findings in blunt and penetrating splenic injuries are discussed with emphasis on the angiographic demonstration of these injuries. The angiographic findings are correlated with the time interval between trauma and radiologic investigation.     

外伤性脾破裂的介入性治疗

目的：探讨外伤性脾破裂采用介入性治疗的临床疗效。方法：33例Ⅲ级以下外伤性脾破裂患者，采用Seldinger法经脾动脉行明胶海绵颗粒部分性栓塞止血。右下腹麦氏点经皮穿刺放置导管引流腹腔积液。结果：部分性脾栓塞术(PSE)对33例脾破裂患者一次性止血栓塞成功，引流通畅，技术成功率100％，有效率97％。17例行腹腔积血回输，全部病例治愈出院。结论：外伤性脾破裂患者经PSE及腹腔引流术治疗疗效确切，创伤小，并发症少，具有较高的临床应用价值。     

外伤性脾破裂脾动脉栓塞的治疗

外伤性脾破裂脾动脉栓塞既保留了脾脏又阻止了脾脏继续出血,临床效果良好。本文介绍最近几年外伤性脾破裂的基础与临床研究。     

监视器在CT增强检查中的应用价值

目的:评估监视器在监测增强CT扫描时对比剂外渗中的价值。方法:患者随机分采用监视器组(A组)和未用监视器组(B组),A组8603例,B组7985例,设定对比剂渗出>50ml为重度外渗,对比剂渗出<10ml为轻度外渗,观察A、B两组皮下对比剂外渗程度。结果:A组发生轻度外渗45例,重度外渗1例,B组发生轻度外渗33例,重度外渗18例。两组比较,其差异具统计学意义(P<0.05)。结论:应用监视器可早期发现穿刺、注射处的异常现象,从而防止重度对比剂外渗的发生。     

Intraparenchymal Doppler ultrasound after proximal embolization of the splenic artery in trauma patients

We studied the changes in proximal embolization of the splenic artery to the intraparenchymal blood flow with Doppler ultrasound. Seventeen trauma patients with spleen injury OIS grade 2–5 underwent embolization of the splenic artery. Peak-systolic velocity (PSV) and end-diastolic velocity (EDV) were measured in intrasplenic arteries initially 1 day after embolization, at early follow-up after 7 days, at intermediate follow-up after 10 weeks, and at late follow-up after 10 months. Resistance index (RI), systolic/diastolic ratio (S/D ratio), acceleration (AC), and acceleration time (AT) were calculated. The results were compared to values from 17 volunteers. RI increased from 0.39 initially to 0.49 (P = 0.002) at intermediate and to 0.52 (P < 0.001) at late follow-up. S/D ratio increased from 1.68 initially to 1.99 (P = 0.002) and to 2.10 (P < 0.001) at intermediate and late follow-up, respectively. Follow-up results of RI and S/D ratio differed significantly from the reference group. AC increased from 1.06 m/s² initially to 1.89 m/s² at late follow-up (P = 0.01). AC at late follow-up was not different from reference group (2.33 m/s²). In conclusion, Doppler ultrasound is a useful tool in the evaluation of improvable intraparenchymal blood flow over time after central splenic artery embolization.     

部分脾动脉栓塞在肝硬化脾功能亢进治疗中的临床运用简

目的：探讨部分脾动脉栓塞在肝硬化脾功能亢进治疗中的疗效及临床意义。方法选择47例肝硬化脾功能亢进患者,采用Seldinger技术用PVA微粒行脾动脉部分栓塞术,并观察术前、术后血象变化。结果47例患者术后1个月、3个月复查,随访3年：外周血白细胞、血小板较术前明显升高;红细胞较前大致相仿。结论部分脾动脉栓塞术治疗脾功能亢进疗效好,并发症少,值得临床运用。     

Iatrogenic splenic injury in postoperative patients: a series of case reports

The purpose of this study was to report case studies of iatrogenic splenic injuries on computed tomography (CT) in symptomatic postsurgical patients. The medical records and CT studies of all patients with injury to the spleen after abdominal surgery were reviewed. CT was performed in the postoperative period, urgently in all patients. Unsuspected splenic injuries were found on CT performed in the early postoperative period in seven symptomatic patients (five women and two men, age range 21–81 years) after various abdominal surgical procedures. Injuries as detected on CT included splenic infarct in five, subcapsular hematoma in two, and laceration of the spleen in one. These findings were the only abnormal abdominal findings in four of the patients and were probably the source of the postoperative abdominal pain and fever. Splenic injury is a rare complication of abdominal surgery. It is often the radiologist who diagnoses the injury, and awareness of this possible complication can obviate further investigations.     

二甲基亚砜、透明质酸酶治疗多西紫杉醇外渗性大鼠皮肤损伤

目的 观察二甲基亚砜(DMSO)、透明质酸酶(HAase)不同用药方法对多西紫杉醇外渗性皮肤损伤大鼠的疗效.方法 30只SD大鼠随机分为6组,每组5只,每只大鼠双后肢造成多西紫杉醇血管外渗模型后,分别外涂DMSO、局部注射HAase、HAase局部注射联合DMSO外涂、外涂生理盐水(NS)、局部注射NS及模型对照组不作任何防治干预.观察各组大鼠多西紫杉醇外渗性损伤程度和损伤愈合时间.结果 各组大鼠损伤程度有差异,其中DMSO组、HAase组及联合用药组的损伤程度较轻,NS外涂组、NS注射组和模型对照组的损伤程度较重.DMSO组的损伤愈合时间为19.10±2.13天,显著短于NS外涂组23.70±2.41天和模型对照组25.70±2.26天(P＜0.01).HAase组和HAase联合DMSO组的损伤愈合时间为12.00±3.00天和14.40±2.30天,显著短于其他4组的愈合时间(P＜0.01),但该两组间无显著性差异.结论 DMSO外涂或HAase单独局部注射均可降低多西紫杉醇外渗性损伤程度,缩短损伤愈合时间,具有良好的疗效.联合用药未能提高疗效.     

脾动脉不全结扎在脾损伤原位保脾中的应用效果

目的 探讨脾动脉不全结扎在脾损伤原位保脾中的应用效果。方法 1990年1月－2000年1月收治22例脾外伤病人，其中男性21例，女1例；年龄14－52岁，平均32岁。采用脾动脉不全结扎，将其管径缩小到原来的1／2－1／3，以便止血及原位保脾。结果 22例保脾均获得成功，术后恢复顺利。随访3个月－1年，观察及随访的主要指标为血液学（IgG、IgM、IgA、C3、C4）、脾脏B超、CT检查及^99mTc扫描，结果证实脾脏的大小、结构及功能均无明显变化。结论 脾动脉不全结扎是一种处理脾外伤原位保脾的有效方法，疗效确切，操作简单，并发症少。     

钝性脾损伤的CT诊断

目的探讨CT非增强扫描对钝性脾损伤的诊断价值。方法回顾性分析经CT非增强扫描并经手术及临床确诊的41例钝性脾损伤。结果脾脏包膜下血肿12例,脾内血肿16例,脾撕裂伤19例,脾粉碎8例,伴有腹腔积血30例。无假阳性,3例假阴性,CT非增强扫描诊断脾损伤敏感性92.7%,特异性100%,准确率92.7%。结论CT非增强扫描能够较好的显示钝性脾脏损伤的表现,为临床治疗提供可靠依据。     

Unexpected death due to spontaneous splenic rupture: A rare case in splenic angiosarcoma

Splenic angiosarcoma (SA) is a rare disease that can cause spontaneous splenic rupture leading to unexpected death. The rare incidence and non-specific clinical presentations made the early correct diagnosis of SA impossible in clinical practice. Even with medical intervention, 80% of patients died within 6 months after diagnosis. Here, we report a man who had complained of abdominal distension for 2 weeks and succumbed to the disease nine hours after admission. Diagnosis of hepatic and splenic angiosarcomas was based on post-mortem histopathological examination and immunohistochemistry, and the cause of death was hemorrhagic shock caused by spontaneous splenic rupture secondary to SA. This present case was the first forensic autopsy of spontaneous splenic rupture secondary to SA, which can highlight the diagnosis of rare diseases in forensic practice, and forensic pathologists should bear in mind these rare diseases even in routine practice.     

Active extravasation of the abdomen and pelvis in trauma using 64MDCT

The objective of this study was to determine the clinical and management implications of the finding of active extravasation in blunt or penetrating trauma patients evaluated with abdomino-pelvic computed tomography (CT) using 64MDCT technology. This HIPAA compliant, retrospective study was IRB-approved, and the need for consent was waived. All adult patients scanned with 64MDCT who sustained blunt or penetrating abdomino-pelvic trauma and had findings of active extravasation at our Level I trauma center during a 30-month period were included. Two radiologists reviewed all abdomino-pelvic CT scans and characterized the active hemorrhage by location, extent, and attenuation on all available phases of imaging. Subsequent therapy and disposition were determined by reviewing the patients’ medical records. The relationship between the location of a source of extravasation and subsequent clinical outcome was evaluated using Fischer’s exact test. The relationship between the size and attenuation of the active hemorrhage and patient outcome were compared using the Wilcoxon rank sum test. One hundred and twenty-five patients with active extravasation were included. Patients with solid organ or pelvic injuries that were managed conservatively or had a negative digital subtraction angiogram had statistically significant smaller areas of active extravasation when compared to those that required intervention or died. When the attenuation values of extravasation are normalized to the intravascular attenuation achieved after intravenous contrast injection, no significant differences were seen based on subsequent clinical outcome. Based on location, those patients with solid organ, gastrointestinal/mesenteric, and pelvic sources of bleeding showed statistically significant higher likelihood of requiring subsequent intervention or dying, compared with those patients with subcutaneous, intramuscular, or retroperitoneal sources of active extravasation who were more likely to be managed conservatively (p < 0.0001, p = 0.005, p = 0.006, respectively). In blunt and penetrating trauma patients evaluated using 64MDCT technology, the location and size of the region of active extravasation are predictive of the type of subsequent clinical management. Normalized attenuation values of the active extravasation, however, are not predictive of subsequent management.     

Intracerebral extravasation of contrast medium after head injury

Summary A case of intracerebral extravasation of contrast medium is reported. In cases of head injury this occurrence is rare and is manifested by persistent images on both frontal and lateral views of the angiogram. This indicates severe cerebral trauma with active hemorrhage and the prognosis is generally bad. A possible mechanism seems to be contrecoup.     

外伤性脾破裂的螺旋CT诊断（附36例分析）

目的评价螺旋CT在外伤性脾破裂诊断中的价值。方法收集我院2001年5月至2008年10月36例明确诊断为脾破裂的CT资料进行分析。结果CT平扫发现脾破裂20例,脾包膜下破裂出血10例,3例CT平扫阴性经作增强扫描证实,3例为迟缓性出血。结论CT扫描有利于对外伤性脾破裂的及时诊断,有利于指导临床治疗。     

超声动态监测在外伤性脾破裂非手术治疗中的应用

目的探讨超声动态监测在外伤性脾破裂非手术治疗中的应用价值。方法对25例外伤性脾破裂患者进行非手术治疗,超声动态监测重点观察脾脏回声和腹腔积液等情况,并严密监测临床体征。结果 25例患者中诊断为真性脾破裂14例,中央性脾破裂5例,包膜下脾破裂6例;首次超声检查确诊16例,经超声动态监测确诊9例。其中22例患者经非手术治疗成功,超声复查提示脾内血肿缩小或基本吸收,腹腔积液减少或消失;3例患者经超声动态监测后确认非手术治疗无效而中转急诊手术。结论超声动态监测脾内损伤情况及腹腔内积血的变化,能直观、实时地显示外伤性脾破裂非手术治疗中的病情进展情况;早期阶段实施床边超声检查有助于提高非手术治疗的成功率,而对可疑者进行超声动态监测则有助于尽早确诊。综合临床体征观察和超声动态监测可作为外伤性脾破裂非手术治疗的首选监测手段。     

多层螺旋CT对外伤性脾破裂的诊断准确性

目的评价多层螺旋CT对外伤性脾破裂的诊断准确性。方法 55例由临床与手术证实的外伤性脾破裂患者均经多层螺旋CT(MSCT)平扫,其中20例又经对比增强CT扫描。对所有患者的CT表现进行了回顾性分析。结果在55例中,起初CT平扫正确诊断50例(90.9%)外伤性脾破裂。增强扫描的20例全部(100%)得到正确诊断。在CT平扫像上,外伤性脾破裂主要表现为脾脏肿大、形态不规则、密度不均匀、边缘模糊及弧形高密度影,而CT增强扫描显示了脾脏内或表面不规则撕裂口、脾内未强化血肿及假性动脉瘤形成。49例(89.1%)患者伴发腹腔积液。早期或轻微脾破裂时,腹腔积液主要见于左侧结肠旁沟及道格拉斯窝。38例(69.1%)患者合并其他脏器或组织损伤。结论多层螺旋CT在外伤性脾破裂的诊断中,具有安全、快速、准确率高等优势。在患者病情许可的条件下,对比增强扫描可提高诊断准确率及合并症的检出率,并能正确分型,为临床选择治疗方案提供可靠依据。     

Partial splenic embolization for hypersplenism concomitant with or after arterial embolization of hepatocellular carcinoma in 30 patients

Purpose To study the value of partial splenic embolization (PSE) for the treatment of hypersplenism in patients undergoing embolization of hepatocellular carcinoma (HCC). Methods Transcatheter hepatic arterial embolization (THAE) combined with PSE was performed in 30 patients with HCC complicating liver cirrhosis, portal hypertension, and hypersplenism. Gelfoam sponge was used as the embolic material for PSE and limited to 100–150 pieces. Results More than 50% of splenic parenchyma was infarcted in 27 patients. Leukopenia and thrombocytopenia were corrected by PSE in 25 of 27 patients with hypersplenism. In 26 patients with esophageal varices, including 5 patients with bleeding, no rebleeding occurred during a 6–17 month follow-up. Hypersplenism was not corrected in 2 of 3 patients whose infarcted splenic parenchyma was less than 50%. No splenic abscesses or other severe complications were observed. Of the 30 patients treated, 19 are still alive after 1 year. Conclusions THAE combined with PSE is a safe and effective measure for patients with HCC.