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目的 评价CT在闭合性肝外伤诊断和治疗中的应用价值。方法 回顾性分析 2 2例闭合性肝损伤患者的CT和临床资料 ,观察CT对闭合性肝损伤诊断的敏感性和特异性 ,并将肝损伤CT表现与手术、临床治疗结果进行对照。结果 2 2例闭合性肝损伤者 ,CT明确诊断 2 1例 ,1例发现腹腔积液。CT诊断的特异性为 95 .5 % ( 2 1/2 2 )。CT分级 :I级 1例 ,II级 10例 ,III级 8例 ,IV级 2例。 8例行非手术治疗 (II级 3例 ,III级 5例 ) ,成功 7例 ,1例因迟发性肝破裂而非手术疗法失败。 1例复查CT发现肝上胆汁聚积 ,经穿刺引流治愈。 14例行剖腹探查术 ,4例术中发现肝脏仍有活动性出血。结论 CT扫描能明确肝损伤的诊断 ,界定损伤类型及严重程度 ,指导合理地选择手术或非手术疗法 ,并能监测康复过程中并发症的发生
Objective To evaluate the value of CT in the diagnosis and treatment of closed liver injury. Methods The CT and clinical data of 22 patients with closed liver injury were retrospectively analyzed. The sensitivity and specificity of CT in the diagnosis of closed liver injury were observed. The CT findings of liver injury were compared with the results of surgery and clinical treatment. Results Twenty-two cases of closed liver injury were diagnosed by CT, 21 cases were diagnosed by CT, and 1 case was found ascites. The specificity of CT diagnosis was 95.5% (2 1/2 2). CT grade: 1 case of grade I, 10 cases of grade II, 8 cases of grade III and 2 cases of grade IV. Eight patients underwent non-surgical treatment (grade II in 3, grade III in 5), successful in 7 and failed in 1 due to delayed hepatic rupture rather than surgical treatment. One case of rechecked CT found that the accumulation of bile on the liver, cured by puncture and drainage. Laparotomy was performed in 14 cases and active hemorrhage was found in 4 cases. Conclusion CT scan can confirm the diagnosis of liver injury, define the type and severity of injury, guide the rational selection of surgical or non-surgical therapy and monitor the occurrence of complications during rehabilitation