^(18)F-FDG PET/CT引导下心脏术后慢性胸骨切口感染并发肋软骨炎的诊疗  

^(18)F-FDG PET/CT Guided Management of Infective Costal Chondritis after Cardiac Surgery

作　　者：张汝凡 冯自豪 陆南杭 谭辉 王剑 亓发芝 ZHANG Ru-fan;FENG Zi-hao;LU Nan-hang;TAN Hui;WANG Jian;QI Fa-zhi(Department of Plastic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Nuclear Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院整形外科,上海200032 [2]复旦大学附属中山医院核医学科,上海200032 [3]复旦大学附属中山医院放射科,上海200032

出　　处：《中国美容医学》2018年第2期25-28,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:评价^(18)F-脱氧葡萄糖(^(18)F-fluorodeoxyglucose,^(18)F-FDG)正电子发射断层扫描/计算机体层摄影(PET/CT)对心脏术后慢性胸骨切口感染所致的感染性肋软骨炎的诊断价值,以及对清创手术的引导作用。方法:连续收集33例心脏术后慢性胸骨切口感染患者,清创重建术前1周接受PET/CT检查。PET/CT检查距原心脏外科手术1.5个月~8年(平均9.2个月)。分别根据PET/CT及CT影像诊断并定位感染肋软骨,与金标准对照。计算感染肋软骨和未感染肋软骨的平均SUVmax。根据PET/CT影像设计清创范围,术后随访18~24个月,评价PET/CT引导下慢性胸骨切口感染并发肋软骨炎的手术效果。结果:33例患者中16例有肋软骨炎,PET/CT对肋软骨炎的定性诊断准确性为100%,CT准确性为72.73%。共发现46处病变,PET/CT和CT对肋软骨炎定位诊断的敏感性、特异性和准确性分别为86.96%、99.67%、98.79%和39.13%、99.67%、95.45%。感染肋软骨和未感染肋软骨的SUVmax分别为6.68±2.95、0.96±0.32。经PET/CT引导,肋软骨炎患者一次清创重建术后治愈率为93.7%。结论:PET/CT诊断心脏手术后肋软骨炎准确性高,定位诊断较CT有明显优势,引导手术清创效果可靠。To evaluate the diagnostic value of PET/CT in the diagnosis of infective costal chondritis caused by chronic sternal wound infection after cardiac surgery and its effect to guide the debridement surgery.Methods A total of33patients with chronic sternal wound infection were enrolled in this study.PET/CT examination was performed one week before debridement and reconstruction surgery with an average interval of9.2months(1.5months-8years).Infected costal cartilages were located according to PET/CT and CT respectively.The results were compared with gold standard to evaluate the diagnostic efficiency of PET/CT and CT.The mean SUVmax of the infected costal cartilage and the uninfected rib cartilage was calculated.Debridement surgery was planned according to PET/CT image.Follow up1.5to2years after debridement and reconstruction surgery was performed to evaluate the effect of PET/CT-guided chronic sternal wound infection with costal chondritis.Results Seven of the33patients had costal chondritis.The accuracy of PET/CT in the diagnosis of costal chondritis was100%and the accuracy of CT was72.73%.Forty-six infective costal cartilages were found in the7patients with costal chondritis.The sensitivity and specificity of PET/CT and CT in the diagnosis of costal cartilage were86.96%,99.67%,98.97%and39.13%,99.67%,95.45%respectively.The SUVmax of infected rib cartilage and uninfected rib cartilage were6.68±2.95and0.96±0.32.Guided by PET/CT image,the cure rate was93.7%after debridement and reconstruction surgery in patients with costal chondritis.Conclusion The accuracy of PET/CT in diagnosis of postoperative costochondral infection,significantly better than CT.It is reliable to perform the debridement with the guidance of PET/CT.

关 键 词：肋软骨炎 外科伤口感染 诊断显像 正电子发射断层显像术 清创术 修复 

分 类 号：R63[医药卫生—外科学]