软组织不透X线异物透视导向经皮钳取治疗  

Percutaneous interventional forceps removal of radiopaque foreign bodies in soft-tissue under fluoroscopic guidance

作　　者：杨秀军[1] 邢光富 史常文 李巍[1] 

机构地区：[1]上海市第八人民医院放射科,200235 [2]上海市第八人民医院普外科,200235

出　　处：《介入放射学杂志》2011年第1期37-41,共5页Journal of Interventional Radiology

基　　金：上海市卫生局课题(项目编号:2008186)

摘　　要：目的探讨透视导向经皮摘除软组织不透X线异物的临床价值与限度。方法 2005年6月至2010年6月上海市第八人民医院诊治软组织不透X线异物损伤患者4 105例,均经X线平片确诊,其中1 591例经CT进一步佐证尤其仿真解剖评价。介入摘除术采用在C臂机X线电视透视引导、局麻下经皮直接钳取异物。结果经皮介入摘除异物者61.34%(2 518/4 105),其中完全治愈率95.07%(2 394/2 518)、部分治愈率4.81%(121/2 518)、失败率0.12%(3/2 518);未行介入治疗者38.66%(1 587/4 105),其中患者自行离院为25.02%(397/1 587)、医技原因为74.98%(1 190/1 587),后者中异物紧贴大血管者占65.22%(1 035/1 587)、伴局部血肿者占2.90%(46/1 587)、伴假性动脉瘤者占1.32%(21/1 587);其他如碎玻璃异物损伤等占5.55%(88/1 587)。CT尤其增强CT三维成像对异物旁动、静脉结构及其损伤的精确揭示,评估了软组织异物损伤介入可摘除性及治疗风险。本组未出现需要治疗的出血、感染、神经损伤等并发症。结论透视导向经皮异物钳取术是软组织不透X线异物损伤有效的微创治疗方法,异物紧贴大血管或伴大血管损伤者多属其禁忌证,术前增强CT尤其三维成像检查对这些复杂病例是必要的,首次提出了血管、非血管双介入异物摘除术理念。Objective To evaluate the clinical value and limitations of percutaneous interventional forceps retrieval technique under fluoroscopic guidance in removing radiopaque foreign bodies in soft-tissue.Methods A total of 4 105 consecutive soft-tissue injury patients with radiopaque foreign bodies,encountered in authors＇ hospital during the period from June 2005 to June 2010,were involved in this study.The diagnosis was confirmed by plain X-ray films in all patients.Additional CT scanning was performed in 1 591 patients,in some of them 3D reconstruction was adopted.With local anesthesia percutaneous interventional forceps retrieval of radiopaque foreign bodies（PIRFB） was carried out under C-arm video-fluoroscopic guidance.Results Of all patients in this study,61.34%（2 518/4 105） was treated by PIRFB（study group）,and 38.66%（1 587/4 105） was not treated with PIRFB（control group）.In study group,the complete and partial curative rate was 95.07%（2 394/2 518） and 4.81%（121/2 518） respectively,and the failure rate was 0.12%（3/2 518）.Of 1 587 patients in control group,25.02%（n=397） left hospital by patient＇s own reasons and 74.98%（n=1190） was discharged from hospital due to medical or technical reasons.In control group,the foreign objects were close to big vessels in 65.22%（1 035/1 587）,large local hematoma was accompanied in 2.90%（46/1 587）,associated traumatic pseudoaneurysm was seen in 1.32%（21/1 587） and the foreign objects were glass pieces and the like were found in 5.55%（88/1 587）.No serious postoperative complications that required specific therapy,such as bleeding,infection and nerve damage,etc.occurred.CT,especially enhanced CT three-dimensional images,could precisely display the vasculatures nearby the foreign body,which helped make the correct judgment of the removal ability and the operation risk for foreign bodies with interventional procedure.Conclusion Percutaneous interventional forceps retrieval technique under fluoroscopic guidance is an effective a

关 键 词：异物 软组织损伤 三维影像 介入放射学 

分 类 号：R649.4[医药卫生—外科学]