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肝臟裂傷建議手術之電腦斷層影像準則
The Suggestive CT Criteria for Operation in Liver Laceration
摘要
利用電腦斷層掃描(CT)來評估肝臟裂傷的嚴重程度，可以幫助外科醫師決定是否需要手術。本文就是針對肝臟裂傷的病人，希望能找出需要手術的電腦斷層影像準則。我們從1993年3月到1996無1月收集41例肝臟裂傷的病人，分析其CT且記錄腹腔內積血的多寡，是否有顯影劑外滲徵象，裂傷的深度，橫斷裂傷以及鄰近器官的損傷等。首先訂立三個電腦斷層影像準則。第一是大量的腹腔內積血，第二是肝臓橫斷裂傷，第三是顯影劑外滲徵象。作一回溯性的預測是否需要手術。我們發現大量腹腔內積血24例有8例接受手術，未接受手術的病人有8例有併發症。肝臟橫斷裂傷12例有4例接受手術，其餘8例未手術的病人都有併發症。而顯影劑外滲有3例，2例接受手術。另外1例未接受手術的病人，由於產生嚴重的併發症如膽汁沉積和血腫塊形成，最後接受經皮下引流。因此我們認為CT可以顯示肝臟裂傷的程度，但對於建議手術治療與否？肝臟橫斷裂傷和顯影劑外滲是有意義的徵象。故此建議施行電腦斷層掃描肝臟裂傷的病患，如果注射顯影劑前之電腦斷層影像有出血時，必需接受靜脈注射顯影劑之電腦斷層掃描檢查。
並列摘要
The severity of liver laceration demonstrated on CT scan may affect the decision making in surgical intervention. The aim of this study is to find the suggestive CT image criteria for operation. From March 1993 to January 1996, we collected data from 41 patients with liver laceration and recorded the amount of hemoperitoneum, the presence of contrast medium extravasation, the depth of laceration, transection injuries of the liver, and adjacent organ injuries. First of all, we designated three CT image criteria including massive hemoperitoneum, transection injury of the liver, and contrast medium extravasation. According to the three criteria above, we predicted the necessity of operation. Among the 24 cases with massive hemoperitoneum, 8 had received operations. Of the remaining 16 non-operative cases, 8 had complications. Of the 12 cases with transection injury of the liver, 4 had received operations and the remaining 8 non-operative cases all showed evident complications. Two of the three cases with contrast medium extravasation had received operations and the remaining non-operative case eventually had to receive percutatenous drainage due to severe complications such as biloma or hematoma formation. We think that contrast medium extravasation and transection injury of the liver are significant signs suggesting operation in the case of liver laceration.