透视下软组织内金属异物取出术经验探讨

Removal of metallic foreign body in the soft tissue under fluoroscopy: 10 years of experiences

目的总结我院10年来于DSA透视引导下软组织内金属异物取出术的经验。方法病人为65例368颗软组织内金属异物存留患者,异物长度为0.2～3.0cm,存留时间为7d～8年。取出方法分二种:对于表浅金属异物在正侧位透视下直接以弯钳取出;对于深部异物则采用套管法,即以钳夹式椎间盘摘除器套装,透视下用定位针将外套管引入到异物处取出。结果共取出346颗金属异物,成功率94.0%,无明显并发症。其中以弯钳直接取出的浅表异物为154颗,以套管法取出的异物为192颗。异物取出时间为30s～20min,X线照射时间1～6min。结论在X线监视引导下,直接以弯钳取出较表浅的异物,以套管法取出较深的软组织内金属异物是治疗软组织内金属异物存留的简单、安全可靠的方法。

Objective To summarize our 10-year experience with percutaneous fluoroscopically guided removal （PFGR） of metallic foreign body （MFB） in the soft tissue. Methods PFGR was performed in 65 patients for removing a total of 368 MFBs from the soft tissues. The MFBs ranged from 0.2 to 0.3 cm in length embedded in the soft tissue for 7 days to 8 years. For superficial MFBs, the MFBs were removed directly with curved forceps under real time fluoroscopy. For deep MFBs, trocar technique was applied using the instruments for percutaneous diskectomy, with the outer cannula inserted toward the foreign body under real-time fluoroscopy followed by MFB removal by grasping forceps. Results A total of 346 MFBs were successfully removed without any serious complications （success rate 94.0%）, including 154 removed directly and 192 MFBs with trocal technique. The time of the procedures and radiation exposure for MFB removal was 30 s to 20 min and 1-6 min, respectively. Conclusions PGFR of MFBs in the soft tissue under fluoroscope is safe and effective. Direct removal using curved forceps is suitable for MFBs in superficial soft tissues, while trocal techniques needs to be utilized for deep MFBs.