3.0T磁共振扩散加权成像指导下不同腹腔镜手术时机治疗盆腔脓肿的疗效分析

Effects of 3.0T diffusion-weighted magnetic resonance imaging guided laparoscopic surgery at different time in the treatment of pelvic abscess

目的分析3.0T磁共振扩散加权成像(MRI-DWI)指导下不同腹腔镜手术时机治疗盆腔脓肿的疗效。方法本院2020年1月~2023年6月收治的60例盆腔脓肿患者按随机数字表法分为对照组(n=30)与观察组(n=30)。对照组抗生素治疗1~7 d内行MRI-DWI检查,对MRI-DWI诊断为急性盆腔脓肿患者开展腹腔镜手术;观察组抗生素治疗7~14 d内行MRI-DWI检查,诊断为慢性盆腔脓肿患者开展腹腔镜手术。比较2组腹腔镜下组织病生理表现、临床治愈率、输卵管切除率、手术情况及随访期内输卵管畅通率、盆腔炎复发率。结果2组患者无中转开腹病例;术前MRI分期与腹腔镜下所见一致,两组治愈率均为100%,术中输卵管切除率无统计学意义(P>0.05);观察组手术时间、术后排气时间短于对照组,术中出血量、并发症发生率低于对照组(P<0.05);观察组输卵管畅通率高于对照组,盆腔炎复发率低于对照组(P<0.05)。结论3.0 T MRI-DWI用于妇科盆腔脓肿手术时机选择具有一定临床价值,且术前抗生素治疗后经MRI-DWI判定为慢性盆腔脓肿的患者腹腔镜手术疗效更佳。

Objective To analyze the effects of 3.0T diffusion-weighted magnetic resonance imaging(MRI-DWI)guided laparoscopic surgery at different time in the treatment of pelvic abscess.Methods Sixty patients with pelvic abscess who were admitted to Suzhou First People's Hospital(Suzhou Branch of the Tenth People's Hospital Affiliated to Tongji University)from January 2020 to December 2023 were divided into the control group(n=30)and the observation group(n=30)using the random number table method.Patients in control group received MRI-DWI examination within 1-7 d of antibiotic therapy,and those with acute pelvic abscess confirmed by MRI-DWI were treated with laparoscopic surgery.Patients in observation group received MRI-DWI examination within 7-14 d of antibiotic therapy,and those with chronic pelvic abscess were treated with laparoscopic surgery.Laparoscopic histopathological manifestations,clinical cure rate,salpingectomy rate,operation,tubal patency rate during the follow-up period and recurrence rate of pelvic inflammatory disease were compared between the two groups.Results No conversion to laparotomy occurred in either group.Preoperative MRI staging was consistent with laparoscopic findings.The cure rate was 100%in both groups.There was no statistically significant difference in salpingectomy rate(P>0.05).Operation time,postoperative exhaust time,intraoperative blood loss and incidence of complications in observation group were significantly shorter or less than those in control group(P<0.05).The tubal patency rate in observation group was significantly higher than that in control group and recurrence rate of pelvic inflammatory disease was significantly lower than that in control group(P<0.05).Conclusion 3.0T MRI-DWI is helpful for selecting the timing of surgery for gynecological pelvic abscess.Laparoscopic surgery is more effective for patients with chronic pelvic abscess confirmed by MRI-DWI after antibiotic therapy.