The Study Of Diagnosis And Treatment For Delayed Splenic Rupture Under The Guidance Of Contrast-enchanced Ultrasonography

Objective:①To establish the animal model of delayed splenic rupture under theguidance of contrast-enhanced ultrasonography.②To explore the value of theappliance of hemostatic agents injected directly into injury site for delayed splenicrupture under the guidance of contrast-enhanced ultrasonography.③To evaluateefficacy and safety of hemostatics of injected gelatin matrix (HIGM) for treatingsplenic trauma in canine model.Material and methods:①A total15mongrel dogs were anesthetized andlaparotomized. The hematoma was formed on the spleen using external force. Thehematoma was ruptured by beating the abdominal wall after72hours. Conventianalultrasound and CEUS were used to detect traumatic lesions of spleen before and afterimpacting. The results of CEUS were compared with those of CECT.②A total14mongrel dogs were anesthetized and laparotomized. The hematoma was formed onthe spleen. Hemocoagulase2mL combined with α-cyanoacrylate1mL were injecteddirectly into injury sites under the guidance of CEUS in splenic trauma. Conventianalultrasound and CEUS were used to detect the injury area and ascites at1st,3rd,7th,14th,21thday. The spleen was harvested on the21thday for gross and pathologicalexamination.③A total of24commercial hybrid dogs underwent celiotomy with creationof uniformly blunt splenic trauma lesion of4cmx4cmx2.5cm (length, width, depth,respectively) by hemostatic clamp. Subjects were prospectively randomized into2groups.The treatment group were treated with HIGM under the guidance of CEUS, the positivecontrol group received thrombin solution. Conventional ultrasound and CEUS wereperformed to record the ascites and the splenic lesion areas at1st,3rd,7th,14th,21thday. Thefine needle biopsy and splenectomy were performed for histopathologic examination. Result:①In4dogs, the hematoma showed by CEUS was gradually reduced during72hours. The CEUS results showed that the splenic hematoma in11canine wasformed continuously during a72hours period and the hematoma area graduallyincreased. The hematoma was ruptured after impacting the abdominal wall.Conventional ultrasound showed that the hamatoma was ill-defined and ascites wasclearly recorded. CEUS results showed that the hematoma was ruptured and activebleeding in the injury site. These conditions were demonstrated via CTscanning.②All animals survived.After injection of hemocoagulase combined withα-cyanoacrylate under the guidance of CEUS, CEUS exam demonstrated that activebleeding disappeared. At4time points, CEUS showed that the aera of hematoma wassignificantly decreased without active bleeding. Conventional ultrasound showed thatthe ascites was decreased. Pathologic examination revealed that the injury site treatedwas covered with glue membrane and no hematoma was observed.③All animals in2groups survived. All dogs succeed stopping hemorrhage after injection of HIGM underCEUS guidence. The area of injury site was gradually reduced at1st,3rd,7thday and all dogs(n=12) were not found splenic lesion at14thand21thday in HIGM group. The splenic lesionwas found in the postive group at1st,3rd,7th, and14thday and all dogs (n=12) were notfound splenic lesion at21thday. At1st,3rdand7thday post-injection, lesion areas werestatistically significant between2groups (p<0.05, all).F ree intraperitoneal fluid was notfound by conventional ultrasound at3rd,7th,14thand21thday in HIGM group. The samecondiction in postive group was14thand21thday. At1st,3rdand7thday post-injection, freeintraperatitoneal fluid were statistically significant between2groups (p<0.05, all).Histopathologic examination showed that there was no no foreign body and foreign bodygranuloma present and the structure of red pulp was repair at7th,14thand21thday. Grossanatomy showed that the splenic injury site was recoved completely without complications.Conclusion: A delayed splenic rupture canine model was established successfullyunder the guidance of CEUS. The hemostatic agents injection therapy for splenictruama under the guidance of CEUS is effective, safe and no adverse effect, whichcarry out the minimal invasive treatment of splenic trauma. This study explored the value of HIGM for hemostasis of splenic trauma, and provided a preliminary experimentalevidence for clinical treatment.