CT血管成像在闭合性动脉损伤中的应用

目的 探讨闭合性动脉损伤的机制、特点,以及64排CT血管成像(CTA)在其诊治中的应用价值.方法 对2005年7月至2007年9月进行CTA检查确诊有血管损伤的24例患者的临床资料进行回顾性分析.结果 CTA检查能准确判断动脉损伤的程度、部位及侧支循环情况.发现动脉闭塞16例,动脉内充盈缺损4例,动静脉瘘2例,假性动脉瘤2例.20例行手术治疗,手术探查发现:动脉完全断裂6例,不完全断裂9例,内膜损伤5例;合并血栓形成4例.其中端端吻合12例,直接修补4例,静脉移植4例;伴取栓术4例.受损动脉术后mL流通畅、血运正常.20例手术患者术中所见与术前CTA诊断一致,准确率为100%.4例CTA显示侧支循环良好者行保守治疗,随访无功能异常表现.结论 CTA是诊断闭合性动脉损伤的准确方法,能判断动脉有无损伤及损伤程度,指导骨科医生治疗,对临床可疑血管损伤者应及时行CTA检查.

Application of CT angiography in closed vascular injury

Objective To assess CT angiography applied in clinical diagnosis of closed vascular injury.Methods A retrospective analysis was conducted to investigate the 24 cases of closed vascular injury who had been diagnosed by CT angiography from July 2005 to September 2007 in our hospital.Results CT angiography could accurately determinate the severity and location of closed arterial rupture and collateral circulation conditions.It revealed arterial occlusion in 16 cases, intra-luminal defects in 6 cases, and Pseudo-aneurysm in 2 cases.Surgical explorations for 20 patients found complete rupture of artery in 6 cases, incomplete rupture in 9 cases, endomembrane injury in 5 cases, and thrombosis in 4 cases.Of them, 12 cases received end-to-end anastomosis, 4 cases primary repair, and 4 cases saphenous vein transplantation.The postoperative blood circulation was normal.No functional abnormality was found in the followed-up for the 4 cases who had undergone conservative therapy due to fine collateral circulation.Conclusion CT angiography is valuable in diagnosing vascular injury and should be indicated for patients with suspicious vascular injury.