The Study Of Hemostasis Therapy For Spleen Trauma Under The Guidance Of Contrast-enchanced Ultrasonography

Objective:①To study different scale of splenic trauma on contrast-enchanced ultrasonography characteristics.②To explore the value of a variety of ultrasound intervention treatment for spleen injury under the guidance of contrast-enchanced ultrasonography and screen the best treatment.Material and Methods: (1) Animal experiment:①Sharp splenic injuries in animal experiments This part was to explore the feasibility and find the best treatment for sharp splenic trauma under the guidance of CEUS in 30 healthy dogs (weighs of 15 to 25 kg) through evaluating different grades of sharp splenic traumatic lesions by baseline and CEUS and using a variety of hemostatic agents to stop bleeding by local injection and percutaneous microwave coagulation therapy to control bleeding under the guidance of CEUS.②Blunt splenic trauma in animal experiments This part of this study was to compare the diagnostic value of CEUS with contrast-enhanced CT for the detection of different grading blunt splenic injuries and investigate immediate and intermediate hemostasis effects after Hemocoagulase andα-cyanoacrylate injected into injury sites under the guidance of CEUS in blunt splenic trauma with III - IV grading in 18 healthy dogs (weighs of 15 to 25 kg). (2) Clinical research: According to the findings of CEUS and CT, and AAST scale standard, 10 splenic patients with III—IV injury grading and stable vital sign received the hemostasis therapy under the guidance of CEUS.Results:(1)Animal experiment:①Sharp splenic injuries in animal experiments Baseline ultrasound was not able to detect the injuries which depth were less 3.0cm, the display rate of baseline ultrasound was about 24% (12/50). After injecting contrast agent, all traumatic regions could be displayed with a rate of 100%. Baseline ultrasound can not show active bleeding in all injuries. The show rate of CEUS was 41.6% for active bleeding. Local injection of some hemostatic agents and percutaneous microwave coagulation therapy can stop splenic bleeding. Hemocoagulase andα-cyanoacrylate local joint injection was the best, safe, simple and effective treatment for active bleeding.②Blunt splenic trauma in animal experiments The concordance for splenic injury was 92.9% compared with CECT, there was no statistics difference about display rate of active bleeding. The grading of splenic injuries by CEUS showed high levels of concordance with CECT. After injection treatment under the guidance of CEUS, CEUS exam demonstrated that active bleeding disappeared, the local treatment areas appeared hyperechoic and blood clots and glue membrance covered the injury areas. Three weeks later, CEUS showed the hyperechoic areas diminished, the injury sites completely healed and greater omentum could be seen around the injuries. (2) Clinical research: Under the guidance of CEUS, all patients succeed stopping hemorrhage after hemostasis injection therapy. No mortality and complication occurred during the process of therapy and short-time follow up, no surgery needed, all patients recovered well without complications (One patient appeared bleeding 24 later and had second hemostasis injection therapy under the guidance of CEUS). Conclusions: CEUS not only significantly enhances the accuracy of different grading of splenic trauma, but also treats splenic trauma patients with III - IV injury grading by local injecting hemostatic agents under the real-time guidance of CEUS. It advances a new treatment mode for splenic trauma.