CT定位下经皮穿刺置管引流在腹部疾病中的临床应用

Clinical application of percutaneous catheter drainage under CT-located in the abdominal diseases

目的 比较CT定位下床旁行经皮穿刺置管引流(percutaneous catheter drainage,PCD)术与CT引导下PCD术在腹部疾病治疗中的临床效果及安全实用性。方法 回顾分析2014年1月至2018年12月期间收治的57例行PCD术患者的临床资料,按随机原则分:CT定位下床旁行PCD(CT定位组)和CT引导下行PCD(CT引导组),记录各组穿刺置管时间、腹部症状缓解时间、引流时间、穿刺费用、治愈率及并发症发生率等情况。结果 两组患者均顺利完成PCD术,CT定位组的治愈率为89.29%(25/28),CT引导组为 93.10%(27/29),两组间差异无统计学意义(χ 2 =0.259, P >0.05)。两组的平均穿刺置管时间、腹部症状平均缓解时间、平均引流时间、术后平均住院时间,分别为[(20.48±4.67)min vs.(18.52±3.71)min、(1.81±0.74)d vs.( 1.74± 0.71 )d、(12.84±4.25)d vs.(11.78±3.97)d、(12.96±3.55)d vs.(11.85±3.26)d],两组间差异无统计学意义( t = 1.710 、0.376、0.629、1.078, P >0.05)。在穿刺费用上,CT定位组(578.5±20.08)元,较CT引导组(1501.8± 144.73 )元明显减少,两组间差异具有统计学意义( t =-32.948, P= 0.01)。CT定位组并发症发生率为 14.29%,包括穿刺处疼痛1例,托管1例,堵管1例,出血1例;CT引导组并发症发生率为10.34%,包括穿刺处疼痛2例,堵管1例,两组间差异无统计学意义(χ 2= 0.205, P >0.05)。所有患者恢复顺利,随访6个月,失访4例,无复发者。结论 CT定位和CT引导下PCD术可达到同等的效果、创伤小、安全实用。虽CT定位下费用低,但技术上要求高,且临床应用范围有一定局限性。

Objective Compare the clinical effect, safety and practicality of percutaneous puncture drainage (PCD) under CT-located or CT-guided PCD in the treatment of abdominal diseases. Methods Clinical data of 57 patients with abdominal diseases, who underwent PCD treatment from Jan 2014 to Dec 2018, were retrospectively analyzed. The patients were randomly divided into two groups: PCD with the CT-located (CT-located group) and CT-guided ( CT- guided group). The puncture catheterization time, relief time of abdominal symptom, drainage time, puncture cost, cure rate and complications rate etc. were compared between two groups. Results PCD was successfully completed in all patients. The cure rate was 89.29% in CT-located group and 93.10 % in CT-guided group;there was no statistically difference between the two groups (χ 2 = 0.259, P >0.05). The average puncture catheterization time, the average relief time of abdominal symptoms, the average drainage time and the average postoperative hospital stay were [(20.48±4.67) min vs.(18.52±3.71) min,(1.81±0.74) d vs.(1.74±0.71) d,(12.84±4.25) d vs.(11.78±3.97) d, and (12.96±3.55) d vs.(11.96±3.26) d], respectively in the two groups;there were no statistically differences between the two groups ( t =1.710, 0.376, 0.629, 1.078, P > 0.05). In the cost of puncture, the CT-located group was significantly less compared with the CT-guided group [(578.5±20.08) yuan vs.( 1501.8± 144.73) yuan], and the difference was statistically significantly ( t =-32.948, P< 0.01). The incidence complications of CT-located group was 14.29%, including 1 case of pain at the puncture site, 1 case of hosting, 1 case of blockage, and 1 case of bleed;the incidence complications of CT-guided group was 10.34%, including 2 cases of pain at the puncture site, 1 case of blockage, there was no statistically difference between the two groups (χ 2=0.205, P> 0.05). After treatment, 4 cases were lost for follow-up. All other patients recovered smoothly without relapse during the 6 months of follow up. Conclusion CT-guided PCD and CT- located PCD can achieve the similar effect for the treatment abdominal diseases with the advantages of minimal trauma, safe and practicality. Although the cost of CT-located PCD is lower, it requires high technology and there are some limitations in the scope of clinical application.