CT、MR三维重建在恶性肿瘤致梗阻性黄疸穿刺定位中的应用价值  

Application value of three dimensional reconstruction of CT and MR imaging in puncture positioning of obstructive jaundice caused by malignant tumors

作　　者：刘金[1] 周胜利 魏宁 曹刚[1] 张根山[1] 吉廷举 LIU Jin;ZHOU Shengli;WEI Ning;CAO Gang;ZHANG Genshan;JI Tingju(Department of Interventional Radiology,Lianyungang Municipal First People’s Hospital,Lianyungang,Jiangsu Province 222000,China)

机构地区：[1]连云港市第一人民医院介入放射科,江苏连云港222000 [2]徐州医科大学附属医院 [3]连云港灌南县第一人民医院

出　　处：《介入放射学杂志》2023年第8期792-795,共4页Journal of Interventional Radiology

摘　　要：目的 探讨CT、MR三维重建在恶性肿瘤致梗阻性黄疸穿刺定位中的应用价值。方法 选择2018年2月至2021年12月江苏省连云港市第一人民医院因恶性肿瘤致梗阻性黄疸行经皮肝穿刺胆道引流(PTBD)和(或)胆道支架植入患者154例,分为研究组81例,对照组73例。研究组术前行胆道系统CT、MR三维重建,根据重建图像明确胆道穿刺皮肤穿刺点、穿刺深度、穿刺水平及穿刺角度后在DSA下行胆道穿刺;对照组选用经典DSA引导下穿刺。比较两组首针穿刺成功率、总体穿刺成功率、穿刺次数、穿刺成功后手术完成率及穿刺并发症发生率,分析三维重建辅助下穿刺定位价值。结果 研究组首针穿刺成功率为90.91%,高于对照组的78.79%;穿刺次数为(1.26±0.54),少于对照组的(1.86±1.11),差异有统计学意义(P<0.05)。两组间总体穿刺成功率和穿刺成功后手术完成率差异无统计学意义。36例(23.38%)出现穿刺并发症,主要为出血、腹痛、气胸和感染等。研究组穿刺并发症发生率为13.58%,低于对照组的34.25%,差异有统计学意义(P<0.05)。结论 CT、MR三维重建技术辅助胆道系统穿刺,可提高首针穿刺的成功率,降低反复穿刺次数和穿刺并发症的发生率,在各级医院和不同年资术者中具有一定的普及意义。Objective To investigate the application value of three dimensional(3D)reconstruction of CT and MR imaging in puncture positioning of obstructive jaundice caused by malignant tumors.Methods The clinical data of 154 patients with obstructive jaundice caused by malignant tumor,who underwent PTBD and/or biliary stent implantation at the Lianyungang Municipal First People's Hospital of China between February 2018 and December 2021,were retrospectively analyzed.The patients were divided into study group(n=81)and control group(n=73).For the patients of the study group,preoperative CT and MRI 3D reconstruction of biliary system was performed,based on the reconstructed images the skin puncture point,puncture depth,puncture level and puncture angle of biliary tract were determined,then the biliary puncture was carried out under DSA guidance.For the patients of the control group,the classical DSA-guided puncture of biliary tract was employed.The success rate of initial needle puncture,the overall puncture success rate,the number of puncture times,the surgical completion rate after a successful puncturing,and the puncture complications were compared between the two groups,and the value of 3D reconstruction of CT and MR imaging in puncture positioning was evaluated.Results In the study group,the success rate of initial needle puncture was 90.91%,which was higher than 78.79%in the control group;the mean number of puncture times was(1.26±0.54),which was less than(1.86±1.11)in the control group,the dfference between the two groups was statistically significant(P<0.05).No statistically significant differences in the overall puncture success rate and the surgical completion rate after a successful puncturing existed between the two groups.Puncture-related complications occurred in 36 patients(23.38%),mainly including bleeding,abdominal pain,pneumothorax and infection.The puncture complication rate in the study group was 13.58%,which was lower than 34.25%in the control group,the difference between the two groups was statisticall

关 键 词：CT、MR三维重建 梗阻性黄疸 恶性肿瘤 胆道穿刺 

分 类 号：R730.5[医药卫生—肿瘤]