目的 探讨杨氏模量值评估超声造影(CEUS)引导下局部注射止血剂治疗肝创伤后局部修复效果的价值.方法 33只健康新西兰兔,用止血钳制作开放性肝创伤模型,CEUS引导下局部注射止血剂氰基丙烯酸酯粘合胶治疗肝创伤灶.治疗后即刻、1周、2周、4周及8周采用剪切波弹性成像技术测量杨氏模量值.治疗后1周、2周和4周对治疗区域行CEUS引导下穿刺活检取组织标本,治疗后第8周处死动物取大体标本,进行病理学检查.结果 31只兔成功建立CEUS引导下局部注射止血剂治疗肝创伤模型.治疗区域即刻、1周、2周、4周和8周杨氏模量最大值分别为(63.05±21.01)、(54.29±13.18)、(41.08±13.29)、(32.09±9.91)和(32.77±9.97)kPa;平均值分别为(46.59±14.32)、(43.31±9.31)、(31.62±9.66)、(25.23±7.66)和(26.57±7.77)kPa;最小值分别为(31.18±10.37)、(28.06±11.24)、(21.57±7.54)、(17.51±7.42)和(16.39±6.69)kPa.治疗区域的弹性最大值、平均值、最小值在不同时间点之间存在差异(F=19.568、22.865、13.799,P均<0.001).病理组织HE染色显示治疗后1周、2周:肝窦轻度淤血,治疗部位及其周围组织炎细胞浸润;治疗后4周、8周:治疗区域异物巨细胞吞噬反应,周围小胆管反应性增生,间质纤维化;8周大体标本显示大网膜覆盖粘连于肝创伤灶,创伤灶表面可见瘢痕组织形成.结论 杨氏模量值评估CEUS引导局部注射止血剂治疗肝创伤出血的预后效果可靠;该方法操作无创、简单、快捷,为临床评估创伤非手术治疗预后提供一种新的方法.%Objective To investigate the value of elastic modulus in assessing the effects of local tissue repair in blunt hepatic trauma after haemostatic injection under the guidance of contrast-enhanced ultrasonography ( CEUS). Methods Thirty-three New Zealand white rabbits were impacted with hemostatic clamp for hepatic trauma models. Cyanoacrylate was injected into the injury sites under the guidance of CEUS. Shear wave flexible measuring was performed immediately, one week later, two weeks later, four weeks later, and eight weeks later, and puncture biopsy of the treated area was performed under the guidance of CEUS after one week, two weeks, and four weeks of the injection. All survivals were killed after eight weeks for local tissue repair evaluation. Results Thirty-one lesions of blunt liver trauma were successfully established. On the immediate, the first week, the second week, the fourth week and the eighth week, the maximum Young ' s modulus of treatment area were respectively (63.05 ±21.01 )kPa, ( 54. 29 ± 13. 18 ) kPa,(41.08 ±13.29)kPa, ( 32.09 ±9.91 )kPa, and ( 32.77 ±9.97 )kPa,mean were (46. 59 ±14.32)kPa, (43.31 ±9.31 )kPa, ( 31.62 ±9.66)kPa, (25.23 ± 7.66)kPa,and(26.57 ±7.77 )kPa, minimum were ( 31. 18 ± 10. 37 )kPa,( 28. 06 ± 11.24 )kPa, ( 21.57 ±7.54)kPa,( 17.51 ±7.42)kPa, and ( 16.39 ±6.69)kPa. There were differences in the maximum, the mean, and the minimum of treatment area at different time points ( F = 19. 568 ,22. 865 ,13. 799 , P = 0. 000 ). Histopathologic examination showed mild congested hepatic sinusoid, and mild inflammatory infiltration in the treatment area and surroundings at the first two weeks. At the fourth and eighth week, swallowed reaction led by foreign body giant cell, bile duct reactive hyperplasia and interstitial fibrosis were found, Gross examination taken at the eighth week demonstrated that the treated lesions were adhered and covered by omentum, and cicatricial tissues were observed on the surface. Conclusions According to this research, elastic modulus is effective in evaluating the prognosis of blunt hepatic trauma after haemostatic injection treatment under the guidance of CEUS. This method is quite simple, rapid and invasive, which might be a new approach for clinical prognostic assessment of non-surgical treatment of liver trauma.
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