CT仿真局部解剖与X线透视双导向的软组织金属异物钳取术

Interventional removal of human soft-tissue metal foreign bodies under double guiding of regional CT virtual anatomy and roentgenoscopy

目的探讨CT仿真局部解剖与X线透视双导向软组织金属异物钳取术的临床应用价值。方法 1315例软组织金属异物患者分为平片组、平片加常规CT组和平片加CT仿真局部解剖组。采用体绘制和动态阈值技术以获取CT仿真局部解剖图像,根据影像学资料先行评价、确定异物钳取术的可行性及具体术式,在"C"型臂X线电视透视引导下经皮钳取异物。结果应用动态阈值变化的体绘制技术的CT仿真局部解剖图像成功获得率为100%,基于增强CT源影像的图像层次丰富,且三维显示了基于平扫源影像未能重构出来的动脉与深部静脉。CT仿真局部解剖准确评估了异物的可摘除性、手术风险,并由此确定了具体术式。平片加CT仿真局部解剖组异物介入摘除术的安全性、成功率与治愈率明显高于其他两组(P<0.01),手术时间和住院时间短于其他两组(P<0.05),并发症发生率和定位器协同使用率低于其他两组(P<0.005)。结论 CT仿真局部解剖结合X线透视双导向软组织金属异物钳取术具有良好的临床价值与效果。

Objective To explore the clinical value of interventional removal of human soft-tissue foreign body（STFB）with double guiding of regional CT virtual anatomy and roentgenoscopy.Methods All of 1315 patients with metal STFBs were divided into 3 groups：Plain film group,plain film plus routine CT group and plain film plus regional CT virtual anatomical group.Volume rendering（VR）with dynamic variable threshold value technique was used to post-process 3-dimensional（3D）CT virtual anatomical images.The feasibility was prospectively estimated,and the specific method of interventional removal of STFBs was determined based mainly on the patients＇ imaging data.Regional anaesthesia was performed before C-arm fluoroscopy-guided percutaneous removal of STFBs.Results The technical success rate of regional CT virtual anatomy reconstructed by spiral thin-slice CT source imaging data with dynamic variable threshold value technique was 100%.It was more abundant in layers of virtual anatomical images reformed from enhanced CT imaging,the arteries and deep veins unreformed from unenhanced CT imaging could be clearly displayed in 3D images.CT virtual anatomical images precisely evaluated the interventional removability,risk and specific operation method.The safety,success and cure rate of interventional removal of STFBs in plain film plus regional CT virtual anatomical group were significantly higher than other two groups（P0.01）.The time of operation and hospital stay was shorter（P0.01）,the complication morbidity and the cooperating usage rate of special positioners were lower than other two groups（P0.05）.Conclusion Interventional removal of mental STFBs has reliable clinic value and good outcome under double guiding of regional CT virtual anatomy and roentgenoscopy.