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복부외상시 전산화단층촬영소견의 분석

Issue Date
1988
Description
의학과/석사
Abstract
[한글] 복부외상시 복부전산화단층촬영은 기존에 의존하였던 진단방법인 단순복부촬영 신우조영촬영 혈관조영촬영 동위원소검사방법보다는 비침습적이고 용이하게 이용할 수 있고 해부학적 해상력이 우수하여 정확하게 손상받은 장기의 유무 및 정도와 범위를 진단할 수가 있고 치료에도 응급수술이나 시험개복수술의 필요성을 결정하는데 결정적인 도움을 주게되었으며 치료계획을 수립하는 데에도 상당한 중요역할을 담당하게 되었다. 또한 많은 환자에 있어 수술없이 보존적치료를 가능하게 하여 시간과 경비절감에도 상당히 기여를 하게되었고 추적검사의 이용으로 병변의 회복 및 변화관찰을 용이하게 하였다. 이에 본 연구자는 1986년 3월부터 1987년 9월까지 연세대학교 원주의과대학 부속병원 응급실로 내원한 복부외상 환자를 대상으로 복부전산화단층촬영 소견을 분석하고 치료와 예후 그리고 추적감사에 대한 전산화단층촬영의 유용성을 관찰하여 다음과 같은 결론을 얻어 이를 보고하고자 한다. 1. 연구기간중에 복부전산화단층촬영을 시행하였던 환자는 모두145명으로 정상은 43명 이상은 102명이었다. 2.해부학적 손상부위별로는 102명의 이상환자중 89명(87%)이 복부내 장기손상을 보였고 나머지 13명이 복부외 장기손상을 보였다. 3. 102명의 이상환자중 장기별로는 201예의 장기손상이 초래되었는데 이중 간손상이 38예로 가장 많았고 후복막강 손상 33예 신손상 31예 흉부하부 손상 31예 비장손상 19예 복부연조직 손상 13예 췌장손상 12예 골손상 10예의 순으로 많았다. 4. 손상유형별로는 간과 췌장 손상에서 실질내출혈형이있고 비장 손상에서는 transected형이 가장 많았다. 5. 신과 후복막강 손상유형에서는 transected 또는 shattered 형이 신손상에서 가장 많았고 peri와 pararenal space 출혈형이 후복막강손상에는 가장 많았으며 신과 후복막강 손상이 같이 동반된 경우도 31예중 26예 였었다. 6. 장과 장간막 손상은 복부전산화단층촬영으로 간접적인 소견 볼 수 있었으나 그 손상의 부위나 정도를 정확하게 진단하기 어려웠으며 다른 검사방법의 사용이 필요할 것으로 생각되었다. 7.손상환자 약 46%에서 복부전산화찰영의 진단으로 수술없이 보존적 치료가 가능했으며 추적검사시에도 복부전산화단층촬영이 매우 유용함을 인지하였다. The Analysis of the C-T findings on Abdominal Trauma In Soo Hong, M.D. Department of Medical Science, Postgraduate SchooL, Yonsei University (Directed by Prof. Hyung Sik Yoo, M.D.) Abdominal C-T scans were performed at Wonju christian hospital in 145 patients with abdominal trauma from the period of march 1986 to september 1987. C-T findings were retrospectively reviewed in conjunction with operation findings and clinical follow-up. The results were as follows : 1. Among the 145 patients, 43 patients showed normal C-T findings and 102 patients showed abnormal C-T findings. 89 patients revealed intraabdominal organ injury and 13 patients revealed extraabdominal injury among 102 abnormal C-T findings . 2. 201 cases of organ injury were detected: liver in 38 cases retroperitoneun in 33 cases, kidney in 31 cases, lower chest in 31 cases, spleen in 19 cases, soft tissue in 13 cases, pancreas in 12 cases and bone 10 cases. 3. The most common type of hemorrhage was intraparenchymal type in lover and pancreas, transected type in spleen. 4. The most common type of hemorrhage was transected or shattered type in kidney and was combined type of perirenal and pararenal hemorrhage in retroperitoneum. 5. It was very difficult in diagnosis of hemorrhage or tear of intestine and measentery without other diagnostic modality. 6. There were 46 cases of hemoperitoneum; abdominal organ injury was the main contributor to hemoperitoneum in 39 cases(85%). In conclusion, the C-T scan was the best modality in diagnosis of the patients with abdominal injury and very valuable modality in the conservative management of abdominal injury or follow-up.
[영문] Abdominal C-T scans were performed at Wonju christian hospital in 145 patients with abdominal trauma from the period of march 1986 to september 1987. C-T findings were retrospectively reviewed in conjunction with operation findings and clinical follow-up. The results were as follows : 1. Among the 145 patients, 43 patients showed normal C-T findings and 102 patients showed abnormal C-T findings. 89 patients revealed intraabdominal organ injury and 13 patients revealed extraabdominal injury among 102 abnormal C-T findings . 2. 201 cases of organ injury were detected: liver in 38 cases retroperitoneun in 33 cases, kidney in 31 cases, lower chest in 31 cases, spleen in 19 cases, soft tissue in 13 cases, pancreas in 12 cases and bone 10 cases. 3. The most common type of hemorrhage was intraparenchymal type in lover and pancreas, transected type in spleen. 4. The most common type of hemorrhage was transected or shattered type in kidney and was combined type of perirenal and pararenal hemorrhage in retroperitoneum. 5. It was very difficult in diagnosis of hemorrhage or tear of intestine and measentery without other diagnostic modality. 6. There were 46 cases of hemoperitoneum; abdominal organ injury was the main contributor to hemoperitoneum in 39 cases(85%). In conclusion, the C-T scan was the best modality in diagnosis of the patients with abdominal injury and very valuable modality in the conservative management of abdominal injury or follow-up.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117409
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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