下肢创伤及手术后患者^(99m)Tc-MAA显像的临床价值  

Clinical evaluation of ^(99m)Tc-MAA imaging in patients with lower extremital posttraumatosis and postoperation

作　　者：谢昌辉[1] 林晓生[2] 马志海[1] 朱琳[2] 段青萍[2] 

机构地区：[1]南方医科大学附属宝安医院核医学科,广东深圳518101 [2]南方医科大学附属宝安医院骨科,广东深圳518101

出　　处：《中国医师杂志》2006年第11期1459-1461,共3页Journal of Chinese Physician

基　　金：广东省深圳市科技计划项目(2005-250)

摘　　要：目的探讨下肢创伤及手术后(LEPP)患者99mTc-大颗粒聚合白蛋白(MAA)显像的临床价值。方法对21例LEPP临床高度疑为急性肺栓塞(APE)患者行99mTc-MAA下肢深静脉显像、肺血流灌注显像(PPI),99mTc-MAA显像提示大面积APE和/或髂股深静脉血栓(DVT)患者行下腔静脉滤网放置+溶栓治疗,小面积APE和/或腘静脉以下DVT单纯溶栓治疗,治疗2~4周后复查PPI。PPI图像上显示一个肺段灌注完全缺损记3分,缺损25%~75%记2分,<25%记1分,无异常记0分,根据记分变化评价疗效。结果99mTc-MAA显像提示13例患者并发大面积APE,8例并发小面积APE,11例并发髂股深静脉DVT,7例并发腘静脉以下DVT。2例(9.5%)在溶栓治疗前死亡,治疗前(10.2±3.8)后(2.8±1.4)PPI记分差异有统计学意义(t=7.75,P<0.01)。结论99mTc-MAA显像对LEPP并发DVT和APE的早期诊断、治疗方案选择和疗效观察均具有重要的临床价值。Objective To evaluate the clinical value of ^99mTc-MAA imaging in patients with lower extremital posttraumatosis and postoperation（LEPP）. Methods 21 LEPP patients with clinical highly suspected acute pulmonary embolism（APE） underwent ^99mTc-MAA veins imaging and pulmonary perfusion imaging（PPI）. Vena caval filters were inserted and thrombolysis were given in patients with big area APE and/or iliofemoral vein thrombosis indicated by ^99mTc-MAA imaging, Thrombolysis was given in patients with small area APE and/or subpopliteal vein thrombosis. PPI was reexamined after 2 ～4weeks＇ treatment, The lung segments with 100% lack of perfusion were marked 3, those with 25% ～ 75% were marked 2, those with less than 25% were marked 1 and normal was marked 0. The therapeutic results were assessed using this marking system. Results There were 13 patients with big area APE, 8 with small area APE, 14 with iliofemoral vein thrombosis, and 7 with subpopliteal vein thrombosis. 2 cases（9.5% ） died before thromobolytic therapy. The marks were significant different before（10. 2±3.8） andafter（2.8±1.4） treatment（ t =7.75,P 〈0.01）. Conclusion ^99mTc-MAA imaging could play an important role in early diagnosis of APE and DVT complications, selecting therapeutic programs and evaluating therapeutic efficiencies in LEPP patients.

关 键 词：下肢/损伤/放射性核素显像/外科学 白蛋白类 

分 类 号：R817.4[医药卫生—影像医学与核医学]