双能计算机断层扫描检查在痛风石切除术中的应用价值  

The Applied Value of Dual-Energy Computed Tomography in Tophus Resection Surgery

作　　者：叶博闻 孙鹏飞 沈军 王凌椿 张永琪 郝泽翰 谢平金 卢启贵 肖涟波 戴号[1] YE Bowen;SUN Pengfei;SHEN Jun;WANG Lingchun;ZHANG Yongqi;HAO Zehan;XIE Pingjin;LU Qigui;XIAO Lianbo;DAI Hao(Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Guanghua Clinical School of Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Shenzhen Hospital of Shanghai University of Traditional Chinese Medicine,Shenzhen 528002,Guangdong China;Institute of Arthritis Research in Integrative Medicine,Shanghai Academy of Traditional Chinese Medicine,Shanghai 200052,China)

机构地区：[1]上海中医药大学附属光华医院,上海200052 [2]上海中医药大学光华临床医学院 [3]上海中医药大学深圳医院 [4]上海市中医药研究院中西医结合关节炎研究所

出　　处：《中国中医骨伤科杂志》2025年第2期24-28,33,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：上海市卫生健康委员会科研项目(20194Y0432)。

摘　　要：目的:探讨痛风石切除术围手术期应用双能计算机断层扫描检查对提升手术疗效及降低并发症的作用。方法:分析61例痛风石患者,涉及81个手术区域。对行痛风石切除术的患者术前、术后分别应用双能计算机断层扫描检查以评估痛风石的体积和分布,统计术后并发症的情况。结果:患者多为男性(59例,96.72%),平均年龄为59.19岁。其中19个手术区域(23.46%)有痛风石破溃合并感染,43个手术区域(53.09%)有痛风石溃疡。双能计算机断层扫描显示术后痛风石的平均体积显著减小(术前20.62 cm^(3)降至术后3.57 cm^(3)),平均清除率为79.08%。14 d后,59个创面(72.84%)一期愈合,22个创面(27.16%)愈合延迟,未达到一期愈合。其中7个创面(8.64%)出现痛风石液化渗出,7个创面(8.64%)出现皮肤缺损,2个创面(2.47%)进行了二次清创。与一期愈合的患者相比,延迟愈合患者术前痛风石的体积更大(33.67 cm^(3)比15.75 cm^(3)),痛风石切除比例更低(68.96%比83.21%),且术前痛风石破溃感染的比例更高(45.45%比13.33%)。患者术后1周后和2周后血清尿酸水平明显低于术前。结论:痛风石切除术围术期应用双能计算机断层扫描检查可以提高痛风石切除率,便于在术前精确定位痛风石,术后采取引流措施及时排除液化痛风石和血肿,避免切口延迟愈合。Objective:The aim of this study is to investigate the role of applying dual-energy computed tomography in the perioperative period of tophus resection surgery in enhancing surgical efficacy and reducing complications.Methods:A total of 61 patients with gout stones were analysed in this study,involving 81 surgical areas.Dual-energy computed tomography was applied preoperatively and postoperatively to patients who underwent tophus resection surgery in order to assess the volume and distribution of gout stones and to count the postoperative complications.Results:Most of the patients were male(59 patients,96.72%)with a mean age of 59.19 years old.Among them,19 surgical areas(23.46%)had gout stone rupture combined with infection in the operated area and 43 surgical areas(53.09%)had gout stone ulcers.Dual-energy computed tomography scans showed a significant reduction in the mean size of gout stones after surgery(20.62 cm^(3) preoperatively to 3.57 cm^(3) postoperatively),with a mean clearance rate of 79.08%.After 14 d,59 wounds(72.84%)achieved one-stage healing,while 22 incisions(27.16%)showed delayed wound healing and did not achieve one-stage healing.7 of the wounds(8.64%)showed gouty stone liquefaction exudation,7 of the wounds(8.64%)had skin defects,and 2 of the wounds(2.47%)underwent secondary debridement.Compared to patients with one-stage healing,patients with delayed healing had a greater volume of preoperative gout stones(33.67 cm^(3) vs 15.75 cm^(3)),a lower percentage of gout stones excised(68.96%vs 83.21%),and a higher percentage of preoperative gout stone breakouts and infections(45.45%vs 13.33%).Patients had significantly lower serum uric acid levels at 1 and 2 weeks postoperatively than preoperatively.Conclusion:The perioperative application of dual-energy compute tomography examination for tophus resection surgery improves the rate of tophus excision,facilitates precise localisation of the gout stone in the preoperative period,and postoperative drainage measures are taken to exclude liquefied gout ston

关 键 词：痛风 痛风石 双能计算机断层扫描 围手术期 

分 类 号：R589.7[医药卫生—内分泌]