CAJ | 학술논문

目的：探讨腹部钝性伤后单纯肾蒂损伤后的 MSCT特征。方法：回顾性分析腹部钝性伤后经CT检查，临床随访，手术证实，其他影响检查互相印证的肾损伤40例，其中肾蒂损伤2例，占肾损伤5％，肾动脉分支损伤2例，占肾损伤的5％，所有患者均行MSCT平扫及增强扫描。结果：肾蒂损伤后MSCT表现：（1）腹腔积血；（2）膈肌脚增厚及膈肌脚浸润征象；（3）膈后间隙片状出血；（4）伤后1～12小时肾轮廓、大小、密度、形态未见异常、肾周围脂肪囊清晰；（5）伤后24小时肾前、肾后筋膜稍增厚，肾周脂肪囊条索状影；（6）伤后3天以后肾体积进一步增大，密度减低，肾周脂肪囊片絮状影，肾筋膜增厚，膈后间隙及膈肌脚积血量未增加，均在肾内侧，未见肾外侧积血；（7）增强扫描可见肾血管内造影剂外溢及肾灌注减低和肾无灌注，可出现肾节段性及全肾梗死，肾皮质呈“线状强化的皮质环征”；（8）合并肠系膜血管损伤及肠管挫伤。结论：肾蒂损伤后早期出血较特征性位于肾内侧，主要位于膈肌脚及膈后间隙，可合并肠系膜血管及肠管损伤，及早增强扫描可发现肾灌注情况，为临床选择合适的治疗方案提供影像学依据，外科医师在作肠道修复手术时应注意避免过分牵拉，引起肾蒂进一步损伤。
목적：탐토복부둔성상후단순신체손상후적 MSCT특정。방법：회고성분석복부둔성상후경CT검사，림상수방，수술증실，기타영향검사호상인증적신손상40례，기중신체손상2례，점신손상5％，신동맥분지손상2례，점신손상적5％，소유환자균행MSCT평소급증강소묘。결과：신체손상후MSCT표현：（1）복강적혈；（2）격기각증후급격기각침윤정상；（3）격후간극편상출혈；（4）상후1～12소시신륜곽、대소、밀도、형태미견이상、신주위지방낭청석；（5）상후24소시신전、신후근막초증후，신주지방낭조색상영；（6）상후3천이후신체적진일보증대，밀도감저，신주지방낭편서상영，신근막증후，격후간극급격기각적혈량미증가，균재신내측，미견신외측적혈；（7）증강소묘가견신혈관내조영제외일급신관주감저화신무관주，가출현신절단성급전신경사，신피질정“선상강화적피질배정”；（8）합병장계막혈관손상급장관좌상。결론：신체손상후조기출혈교특정성위우신내측，주요위우격기각급격후간극，가합병장계막혈관급장관손상，급조증강소묘가발현신관주정황，위림상선택합괄적치료방안제공영상학의거，외과의사재작장도수복수술시응주의피면과분견랍，인기신체진일보손상。
Objective:To study the simple renal pedicle injury after blunt abdominal injury after MSCT features .Methods:After blunt abdominal injury were retrospectively analyzed by CT examination , clinical follow-up, surgery confirmed that other effects inspection to confirm each other 40 cases of renal injury , including 2 cases of renal pedicle and accounted for 5%of kidney damage renal arterial injury in 2 cases, accounting for 5%of the kidney damage , all patients were performed MSCT scan and enhanced scan .Results:After injury of renal pedicle hemoperitoneum MSCT performance: ( 1 ) , ( 2 ) thickening and diaphragm diaphragm the feet infiltrating signs , ( 3 ) the clearance sheet after bleeding , (4) 1-12 h after injury of renal contour , shape, size, density did not see abnormalities , renal adipose capsule around the clear, (5) after the injury after 24 h before the kidney, renal fascia slightly thickened, week renal adipose capsule a funicular , (6) after 3 days after injury kidney volume increased further , density decreased , renal adipose capsule flocculent shadow , zhou renal fascia thickening , diaphragmatic after clearance and diaphragm foot HP did not increase , both in the renal inside , no kidney laterally hemorrhage, (7) enhanced scanning contrast agents within the visible renal vascular and renal perfusion reduction and renal perfusion , could appear renal segmental and complete renal infarction , renal cortex showed linear strengthening "cortical ring sign"(8) merger and bowel mesenteric vascular injury contusion .Conclusion:Early bleeding after renal pedicle injury should be characteristic medial to the kid -ney, mainly in the diaphragm and diaphragm foot clearance , after merger of mesenteric vascular and bowel lesions , enhanced scan could be found as early as possible renal perfusion , provide imaging basis for clinical choice suitable treatment , surgeons in excessive force should be paid attention to when the intestinal surgery to repair , to avoid further injury of renal pedicle .