摘要
目的:探索耐多药肺结核(MDR-TB)患者低剂量CT定位下空洞注药术的临床应用价值。方法:2006年1月-2011年12月在本院就诊的痰菌阳性耐药空洞型肺结核病例154例,随机分为低剂量CT(30mA)定位下空洞介入治疗组(78例)及常规剂量CT(150mA)定位下空洞介入治疗组(76例)。常规消毒麻醉,在CT导向下根据自制定位铅栅选择合适穿刺点、进针角度及路径后行空洞内联合灌注给药。比较两种不同剂量CT扫描在总辐射量、图像质量、穿刺治疗成功率、并发症发生率及临床疗效方面有何差异。结果:低剂量CT介入治疗组的CTDIvol 0.99mGy,DLP(14.20±1.46)mGy·cm;ED(0.199±0.02)mSv;常规剂量组CTDIvol 4.92mGy,DLP(75.92±7.42)mGy·cm;ED(1.06±0.10)mSv。统计学结果示两组患者的辐射量有显著性差异(t=-71.18,P=0.00);但在图像质量可接受性方面,两组患者的图像均为100%(评分均>2分);关于穿刺成功率及患者的远期疗效,低剂量组与常规剂量组相比差异无显著性(P>0.05)。结论:低剂量CT引导下的空洞注药技术在大大降低辐射量的同时既保障了穿刺治疗的成功,又促进了MDR-TB患者的疾病转归,因此值得在临床上普遍开展。
Objective：To study the clinical feasibility of intra cavity injection of anti-tuberculosis medicine under low close CT guidance for patients having multi-drug resistant pulmonary tuberculosis （MDR-TB）. Methods： From January 2006 to December 2011,154 consecutive patients with pulmonary tuberculosis having positive sputum smear were enrolled in our study. Patients were divided randomly into two groups：group one composed of 78 patients underwent percutaneous intra- cavity injection of anti-tuberculosis medicine under low-dose CT guidance （30mA）,while for the other 76 patients standard dose CT-guided procedure （150mA） was undertaken. After sterilization, anesthesia,localization of lesion with self-made lead grid marker, appropriate puncture angle and pathway were selected, anti-tuberculosis drugs were injected into the pulmonary cavity. The overall radiation dose, image quality, success rate of treatment procedure, incidence of complication and clinical outcome were compared between the above-mentioned two groups. Results：The CTDlvol （volume CT dose index）, DLP and ED was 0. 99mGy, （14. 20 ±1. 46） mC/y · cm, and （0. 199 ±0. 02） mSv respectively in low-dose CT group, whereas 4.92mGy, （75.92±7.42）mGy · cm and （1.06 ±0. 10）mSv respectively in standard-dose group, with significant statistic differences （t=-71.18,P=0.00）. However,for the image quality,the acceptance rate of these two groups was 100%, with the score ≥2, no statistic difference was existed. No significant statistical difference was existed regarding to successful puncture rate and long-term outcome （P〉0.05）. Conclusion： Percutaneous intra cavity injection of anti-tuberculosis medicine under low-dose CT-guidance could not only reduce the radiation exposure, but also provide a safe and precision technique, thus deserving to be applied comprehensively in clinical practice.
出处
《放射学实践》
2013年第10期1069-1072,共4页
Radiologic Practice
关键词
结核
肺
广泛耐药结核
体层摄影术
X线计算机
辐射量
Tuberculosis,pulmonary
Extensively drug-resistant tuberculosis
Tomography,X-ray computed
Radiation dose
