断指再植术后早期^(99)Tc^m-RBC显像的临床价值

The clinical value of early ^(99)Tc^m-RBC blood pool imaging in patients with replanted fingers

目的 探讨断指再植术后早期 (<48h)动态99Tcm RBC血池显像 (BPI)的临床价值。方法 30例断指再植患者于术后 48h内进行 5次BPI,计算并对比分析再植指和正常指的放射性比值 (T/NT) ,根据再植指放射性聚集程度将显像结果分为 0、Ⅰ、Ⅱ级。结果 再植指通过 4次高压氧(HBO)治疗后的T/NT(0 6 2 4± 0 310 )明显高于治疗前 (0 413± 0 2 74,t=2 79,P <0 0 1) ,4次治疗后的T/NT变化情况可作为终止HBO治疗的指征 ;治疗前显像为 0、Ⅰ、Ⅱ级的T/NT分别为 0 149±0 0 6 3、0 46 3± 0 0 5 0、0 840± 0 2 0 2 (t=11 87、9 30、5 77,P <0 0 1) ,血管危象发生率分别为 10 0 %、2 0 %、0 (χ2 分别为 2 8 8、2 0 0 ,P <0 0 1) ;48h时显像为 0、Ⅰ、Ⅱ级表现的再植指需再次手术和 (或 )坏死发生率分别为 10 0 %、8 3%、0 (χ2 分别为 11 7、18 0 ,P <0 0 1)。结论 BPI对断指再植术后早期动态监测疗效。

Objective To study the clinical value of early(<48 h) 99Tc m-RBC blood pool imaging(BPI) in patients with replanted fingers (RF). Methods Five times of BPI were performed on each of the 30 patients with RF, at 4～8,8～12, 24, 36 and 48 h after the replantation surgery, and that was one time before and 4 times after the hyperbaric oxygen(HBO) treatment on the patients. The radioactivity uptake of replanted finger/normal finger ratio(T/NT) was analyzed using region of interest analysis. The vascular crisis and prognosis were predicted. 0, Ⅰ and Ⅱ groups were classified according to their radionuclide distribution. The change of T/NT was comparatively studied. The vascular crisis and prognosis were predicted. Results The replanted finger T/NT(0.624±0.310) after 4 times of HBO treatment was significantly higher than before the treatment (0.413±0.274, t=2.79,P<0.01), the change was the standard of stopping HBO treatment. 0, Ⅰ and Ⅱ groups T/NT of BPI before HBO were 0.149+0.063, 0.463±0.050 and 0.840±0.202(t=11.87, 9.30, 5.77, P<0.01), respectively, their vascular crisis ratios were 100%, 20.0% and 0(χ 2=28.8,20.0, P<0.01), respectively. The rates of repeated operation and (or) necrosis in 0, Ⅰ and Ⅱ groups (according to their T/TN of BPI at 48 h after operation were 100%, 8.3% and 0(χ 2=11.7,18.0, P<0.01),respectively. Conclusions BPI could play an important role on dynamic evaluating the early therapeutic survellance, predicting the vascular crisis and prognosis, and selecting the next treatment programme in the patients with RF.