超声造影诊断肝破裂的临床应用研究

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1、超声造影诊断肝破裂的临床应用研究［摘要］目的评价超声造影检查在肝破裂诊断屮的临床应用价值。方法收集2012年12月〜2015年6月广西医科大学第一附属医院收治的28例肝破裂(包插外伤性和自发性破裂)超声造影声像图特征。观察肝损伤的部位及损伤程度，比较常规超声与超声造影对肝破裂诊断准确率，所有病例均由CT及手术证实。结果超声造影观察下，19例肝癌患者中8例破裂口未见造影剂明显移动，破裂口周围可见积血及血肿，11例破裂口处可见造影剂自破裂口向肝外呈“喷射状”“泉涌状”移动；7例外伤性肝破裂患者中3例为肝破裂肝包膜下血肿，肝内病灶中央造影全程始终无增强，周边

2、呈点线状增强，包膜下血肿全程始终无增强，另4例破裂病灶内造影全程中央始终无增强，周边呈点线状增强，其中2例破裂口处可见造影剂自破裂口向肝外呈“云雾状”扩散；2例自发性肝脓肿破裂患者肝边缘破裂口处可见造影剂自破裂口向肝外呈“喷射状”移动。常规超声对自发性肝癌破裂、外伤性肝破裂和口发性肝脓肿破裂的诊断准确率分别为73.7%、85.7%和100.0%；超声造影诊断准确率均为100.0%。超声造影诊断肝破裂的诊断准确率显著高于常规超声，两者比较差异有统计学意义(P<0.05)o结论超声造影可实时、动态地观察闭合性肝损伤的部位、范围及是否有活动性出血的情况，对临

3、床治疗具有重要的参考价值。［关键词］超声造影；肝破裂；超声检查；腹部创伤［中图分类号］R445.1［文献标识码］A［文章编号］1673-7210(2016)01(a)-0113-04Studyonclinicalapplicationofcontrast-enhancedultrasooundindiagnosisofhepatorrhexisLUTingtinglXUBanghao2LIZhixianl1.DepartmentofUltrasound,theFirstAffiliatedHospitalofGuangxiMedicalUniversi

4、ty，GuangxiZhuangAutonomousRegion,Nanning53002LChina；2.DepartmentofHepatobiliarySurgery,theFirstAffiliatedHospitalofGuangxiMedicalUniversity,GuangxiZhuangAutonomousRegion，Nanning53002LChina[Abstract]ObjectiveToevaluateclinicalapplicationvalueofcontrast-enhancedultrasound(CEUS)int

5、hediagnosisofhepatorrhexis.MethodsFromDecember2012toJune2015,inFirstAffiliatedHospitalofGuangxiMedicalUniversity,ultrasoundimagingcharacteristicsof28patientswithhepatorrhexis(includingtraumaticandspontaneousrupture)werecollected・Theinjurylocationandextentofdamagewereobserved,the

6、accuracyofconventionalultrasoundandcontrast-enhancedultrasoundindiagnosisofhepatorrhexiswerecompared.AllcaseswereconfirmedbyCTandsurgery.ResultsUndertheobservationofCEUS,8casesof19hepaticcarcinomapatientswithhepatorrhexisshowedbloodandhematomaaroundtherupturewithoutsignificantmo

7、vementofthecontrastagent,andother11casesshowed"jet—like"movementofcontrastagentfonntherupture.3casesof7patientswithtraumatichepaticrupturewereliversubcapsularhematoma,whichshowednoenhancementinthecenteroflesionandthesubcapsularhematoma,butitshowedpointed-1ikeenhancementaroundthe

8、lesion.Theothercasesshowednoenhancementinthecen