摘要
目的探讨不同影像引导方式下经皮胃造瘘术的临床特点,为临床合理选择影像引导方式提供参考。方法回顾性分析2014年1月至2016年12月277例在本院介入科行经皮胃造瘘术患者的临床资料,按照影像引导方式分为3组,A组数字减影血管造影(DSA)透视引导,B组C臂CT引导,C组全程CT引导,对比分析各组的技术成功率、并发症发生率、手术时间及患者辐射剂量情况。结果3组患者技术成功率(93.8%比97.3%比100%,χ^2=2.797,P=0.247)、并发症发生率(10.0%比11.3%比20.0%,r=1.343,P=0.511)比较差异无统计学意义。3组患者手术时间[(25.57±5.99)min比(29.01±6.63)min比(45.47±8.98)min,χ^2=27.977,P〈0.001]、患者辐射剂量[(27.30±19.27)mGy比(145.07±106.08)mGy比(2590.26±1088.22)mGy,χ^2=204.444,P〈0.001]比较差异有统计学意义;A组和B组手术时间、患者辐射剂量均明显低于C组(均P〈0.001),其中A组手术时间最短、患者辐射剂量最低(与B组比较,P≤0.001)。结论经皮胃造瘘术应当首选DSA透视引导,但是术前应常规行上腹部cT扫描排除左肝大和胃前横结肠等情况。所用DSA机带有C臂cT功能时,亦可直接采用C臂cT引导。在DSA和C臂cT引导失败时,全程CT引导可作为一种补充引导方式。
Objective To investigate the clinical characteristics of percutaneous gastrostomy guided by different imaging techniques, in an effort to inform selection of imaging guidance. Methods A retrospective analysis was conducted on the clinical data of 277 patients who underwent percutaneous gastrostomy at Affiliated Tumor Hospital of Zhengzhou University from January 2014 to December 2016. The patients were divided into three groups according to the imaging techniques used, i. e. group A guided by fluoroscopy of digital subtraction angiography (DSA), group B by C-arm computed tomography (CT), and group C by CT throughout the process. The technical success rate, complication rate, operation time and patient's radiation dose were com- pared among the three groups. Results There was no significant difference in technical success rate (93.8% vs. 97.3% vs. 100%, X2=2.797, P=0.247) and complication rate (10.0% vs. 11.3% vs. 20.0%, X2= 1. 343, P=0. 511) among the 3 groups, but the operation time ± (25.57±5.99) min vs. (29. 01±6. 63) rain vs. (45.47±8. 98) min, X2 = 27. 977, P〈O. 001 ] and patient's radiation [ (27. 30± 19. 27) mGy vs. ( 145.07± 106.08) mGy vs. (2 590. 26± 1 088. 22) mGy, X2 = 204. 444, P〈 O. 001 ± dose were significantly different (X2=87.977, P〈0.001; X2 =204.444, P〈0.001), with group A and B lower than group C (P〈 0. 001 ) and group A lower than group B (P±〈0. 001 ). Conclusions DSA fluoroscopic guidance should be the first choice for percutaneous gastrostomy, but before the operation, abdominal CT scan should be performed toexclude such situations as hypertrophy of left lobe of liver, and colon in front of the stomach. If the DSA ma- chine is equipped with C-arm CT function, the surgery can also be directly guided by C-arm CT. Complete CT guidance can be used as a supplement in the case of failure by both DSA fluoroscopy and C-arm CT guidance.
出处
《中华临床营养杂志》
CAS
CSCD
2017年第6期378-382,共5页
Chinese Journal of Clinical Nutrition
关键词
胃造口术
透视
C臂CT
体层摄影术
X线计算机
Gastrostomy
Fluoroscopy
C-arm computed tomography
X-ray computed tomography