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頁籤選單縮合
題 名 | Computed Tomography in the Determination of Surgical Emergency for Symptomatic Abdominal Aortic Aneurysm=電腦斷層作為有症狀的下腹主動脈瘤是否需緊急手術依據的臨床價值 |
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作 者 | 施俊哲; 賴曉亭; 張燕; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:4 1998.04[民87.04] |
頁 次 | 頁210-215 |
分類號 | 416.263 |
關鍵詞 | 破裂性腹主動脈瘤; 電腦斷層; Computed tomography; Symptomatic aneurysm; |
語 文 | 英文(English) |
中文摘要 | 背景 腎動脈下腹主動脈瘤是最常見的動脈瘤,平常無任何明顯症狀,故常被忽 略。然而一旦病患有腹痛等症狀時,必需懷疑是否已經破裂,所以如何立即鑑別診斷,且進 行迅速有效的手術,是破裂主動脈瘤患者能否存活的最重要決定因素。超音波掃描及電腦斷 層是最常應用的鑑別診斷工具,但何者最適合使用於急症病人,迅速確實,則必需進一步分 析及推薦。 方法 從1989年1月至1995年1月,共53位患者,因有症狀的腹主動脈瘤經緊急會診後, 使用電腦斷層作鑑別診斷工具,其中40位患者同時也接受了超音波掃描。再對應手術時觀 查的結果,進一步分析比較個別準確性及臨床適用性。 結果 電腦斷層作鑑別診斷破裂性腹主動脈瘤優於超音波掃描。電腦斷層的診斷敏感性為88 ﹪,特異性為88﹪,總體準確性為89﹪。相較於超音波掃描,卻有較高的假正值率33﹪, 較低的診斷特異性62﹪,及總體準確性72%。 結論 迅速的鑑別診斷是影響破裂性腹主動脈瘤存活率的最重要因素。超音波掃描雖然便 利,但有太多人為因素,又受腹部腸氣影響,故不如電腦斷層準確,如果能於血循穩定時, 安排電腦斷層檢查,對於破裂囗位置判斷、血塊堆積量、位置及出血情形等有更精確的了解; 利於術前手術策略的計劃,及存活率和罹病率的預估。 |
英文摘要 | Background. What is the best surgical timing for symptomatic AAA? Surely, the answer depends on accurate and prompt diagnosis of "rupture or not". Abdominal CT is one of the reliable and familiar diagnostic tools. We will present our own CT classification method for symptomatic AAA which is used as the guideline for "emergency or not". Methods. From January 1989 to January 1995, 52 patients with symptomatic AAA received diagnostic CT scan for quick disease differentiation and determination of surgical emergency. The findings were classified into four categories. Category I included 26 patients with intact aorta; Category Ⅱ included four patients with contained retroperitoneal abdominal aortic leakage; Category III included 14 patients with contained massive retroperitoneal hematoma; and Category IV included eight patients with retroperitoneal or intraperitoneal active bleeding. Results. Compared with the standard diagnosis of rupture via laparotomy, CT is an excellent tool, showing 88% sensitivity and 88% specificity. This is better than sonography, which has a high false-positive rate of 33 % and low specificity of 62%. Hospital mortality was distinctive with 4.3% in Category I, none in Category Ⅱ, 25% in Category Ⅲ and 87.5% in Category Ⅳ. Conclusions. In our experience, CT scan is a better diagnostic tool than sonography for symptomatic AAA. Even the delay imposed by obtaining a preoperative CT scan in patients with possible ruptured aneurysm does not adversely affect the patient's outcome. The information obtained significantly aids not only preoperative but also intraoperative management. |
本系統中英文摘要資訊取自各篇刊載內容。